Humanizing Substance Abuse: A Theory-Based Educational Intervention for Undergraduate Nursing Students.

BACKGROUND: Healthcare providers, as well as healthcare students, have been found to harbor negative attitudes toward individuals with substance abuse disorders, impacting the care they give and subsequently creating poor patient outcomes. PURPOSE: This study seeks to determine the effectiveness of an educational intervention, grounded in theory, toward changing nursing student attitudes regarding patients with a substance abuse disorder. METHODS: Nursing students participated in a teaching intervention, developed using the experiential learning theory, that utilizes modalities for each kind of learner aimed at reducing bias toward this population. The Medical Condition Regard Scale was used pre/post intervention to determine regard toward patients with the diagnosis of substance abuse. RESULTS: Student nurses maintained the least favorable attitudes toward individuals who abuse substances in comparison with patients with the diagnoses of pneumonia or gastroesophageal reflux disease; there were significant differences in attitudes toward patients who abused substances before and after participation in the educational intervention, with postparticipation attitudes being significantly more positive than attitudes before participation. Students found the educational intervention and debriefing highly satisfactory. IMPLICATIONS: This educational intervention can provide a cost-effective, easy-to-replicate, time-efficient learning activity that could be added to undergraduate nursing curriculum.

A qualitative system dynamics model for effects of workplace violence and clinician burnout on agitation management in the emergency department.

BACKGROUND: Over 1.7 million episodes of agitation occur annually across the United States in emergency departments (EDs), some of which lead to workplace assaults on clinicians and require invasive methods like physical restraints to maintain staff and patient safety. Recent studies demonstrated that experiences of workplace violence contribute to symptoms of burnout, which may impact future decisions regarding use of physical restraints on agitated patients. To capture the dynamic interactions between clinicians and agitated patients under their care, we applied qualitative system dynamics methods to develop a model that describes feedback mechanisms of clinician burnout and the use of physical restraints to manage agitation. METHODS: We convened an interprofessional panel of clinician stakeholders and agitation experts for a series of model building sessions to develop the current model. The panel derived the final version of our model over ten sessions of iterative refinement and modification, each lasting approximately three to four hours. We incorporated findings from prior studies on agitation and burnout related to workplace violence, identifying interpersonal and psychological factors likely to influence our outcomes of interest to form the basis of our model. RESULTS: The final model resulted in five main sets of feedback loops that describe key narratives regarding the relationship between clinician burnout and agitated patients becoming physically restrained: (1) use of restraints decreases agitation and risk of assault, leading to increased perceptions of safety and decreasing use of restraints in a balancing feedback loop which stabilizes the system; (2) clinician stress leads to a perception of decreased safety and lower threshold to restrain, causing more stress in a negatively reinforcing loop; (3) clinician burnout leads to a decreased perception of colleague support which leads to more burnout in a negatively reinforcing loop; (4) clinician burnout leads to negative perceptions of patient intent during agitation, thus lowering threshold to restrain and leading to higher task load, more likelihood of workplace assaults, and higher burnout in a negatively reinforcing loop; and (5) mutual trust between clinicians causes increased perceptions of safety and improved team control, leading to decreased clinician stress and further increased mutual trust in a positively reinforcing loop. CONCLUSIONS: Our system dynamics approach led to the development of a robust qualitative model that illustrates a number of important feedback cycles that underly the relationships between clinician experiences of workplace violence, stress and burnout, and impact on decisions to physically restrain agitated patients. This work identifies potential opportunities at multiple targets to break negatively reinforcing cycles and support positive influences on safety for both clinicians and patients in the face of physical danger.

An Interprofessional Simulation-Based Orientation Program for Transitioning Novice Nurses to Critical Care Roles in the Emergency Department: Pilot Implementation and Evaluation.

BACKGROUND: The emergency department (ED) relies on high-functioning teams to deliver consistent and safe patient care. Experts recommend that both emergency physicians and ED nurses participate in team training. However, there are currently no nationally accepted curricula for either profession to embed this training in their professional development, particularly for health workers who are novice or transitioning into critical care roles. METHODS: An interprofessional educator team designed and embedded a series of simulation scenarios within a novel orientation program for novice nurses transitioning to critical care roles in the ED to teach clinical and teamwork skills for conjoint groups of resident physician and novice nurse learners. The team created four interprofessional simulations to represent the acuity and breadth of patient populations in the ED critical care bays. INTERVENTION/REFINEMENT: To date, the team has conducted 24 two-week orientation sessions for 48 nurses and 51 resident physicians. Overall mean scores for the Debriefing Assessment for Simulation in Healthcare (DASH) instrument from nursing participants in the first 18 sessions were high. Qualitative evaluation data from both nurses and physicians demonstrated a positive impact of the simulations and provided insight into respective roles, identities, and priorities across professions. Participant feedback led to iterative steps in refinement of the simulations, including adjustments in debriefings and logistics of the orientation program. IMPLICATIONS FOR PRACTICE: A team-based interprofessional simulation program was found to be feasible and acceptable for practicing novice physicians and nurses as part of a nursing critical care orientation program in the ED. Future work will assess the program's long-term impact on teamwork and safety in the actual clinical environment.