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.

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.

Plagiarism in the Graduate Nursing Program: Occupation Stress or Lack of Knowledge?

Student plagiarism has always been a concern for nursing faculty. Faculty have noticed an increase in graduate student plagiarism during COVID-19. While research regarding plagiarism and graduate nurses and occupational stress and plagiarism is sparse, neurobehavioral research on decision-making provides some clues for faculty concerned about graduate nurses working and attending school during a pandemic.

Resilience in Mothers of Very-Low-Birth-Weight Infants Hospitalized in the NICU.

OBJECTIVE: To develop the theme of Resilience of mothers of very-low-birth-weight infants in the NICU from a qualitative study on maternal role attainment. DESIGN: Secondary analysis using retrospective interpretation, that is, the further development and refinement of content related to resilience that was identified in the original data. SETTING: A tertiary NICU in Chicago. PARTICIPANTS: Twenty-three English-speaking, predominantly single (74%), minority (Black [57%], Hispanic [17%]), low-income (78%), primiparous (78%) mothers of very-low-birth-weight infants. METHODS: Narrative analysis and core story creation were used to analyze the data related to resilience. A narrative of each participant's birth and NICU story was constructed and recurring meanings were analyzed. Identified patterns were compared across narratives to create one coherent core story that synthesized themes common to all stories. RESULTS: Participants found meaning in redefining their priorities to become advocates for their infants and to "pick themselves up for their babies" by using resources that actively promoted their mental health. NICU-based breastfeeding peer counselors and bedside nurses helped guide participants through their NICU experiences, provided support so participants could gain confidence and competence, and allowed participants to cope with their long-term psychological distress. CONCLUSION: Participants demonstrated resilience as they learned to live with what was beyond their control. NICU nurses are ideally positioned to capitalize and expand on mothers' health-promoting strengths, resources, and coping strategies to help them further decrease their NICU-related stress and better integrate mothering behaviors into their lives long after NICU discharge.

Depression, anxiety, and perinatal-specific posttraumatic distress in mothers of very low birth weight infants in the neonatal intensive care unit.

OBJECTIVE: To compare the trajectories and determine the predictors of maternal distress defined as a continuous spectrum of symptomatology and elevated symptomatology, of depression, anxiety, and perinatal-specific posttraumatic stress (PPTS), in mothers of very low birth weight (VLBW) infants throughout the neonatal intensive care unit (NICU) hospitalization. METHOD: Sixty-nine mothers completed psychological questionnaires within the first month of their infant's NICU hospitalization and again 2 weeks before NICU discharge. Multiple regression models determined maternal psychological, reproductive, sociodemographic, and infant medical predictors of maternal distress. RESULTS: Perinatal-specific posttraumatic stress remained stable throughout the NICU hospitalization, whereas other aspects of distress declined. Previous psychological history and infant medical variables predicted higher PPTS but no other aspects of distress. Reproductive variables predicted anxiety and PPTS; history of fetal loss initially predicted lower PPTS but throughout hospitalization primipara status emerged as a predictor of higher anxiety and PPTS. Sociodemographic variables predicated initial, but not later, depressive distress. CONCLUSIONS: Psychological screening is important in the NICU. The PPTS profile suggests it may require distinct treatment. Primiparas should be targeted for intervention.

Maternal psychological distress and visitation to the neonatal intensive care unit.

AIM: To examine associations between maternal neonatal intensive care unit (NICU) visitation rates, maternal psychological distress ('distress') and preterm infant outcome post-NICU discharge in a contemporary cohort of very low birthweight (VLBW) infants. METHODS: This was a prospective study of 69 mothers and their VLBW infants. Distress was assessed 1-month postbirth, 2 weeks prior to NICU discharge and after NICU discharge at 4-month corrected age (CA). Maternal NICU visitation rates were calculated for the first 2 weeks and 1-month postbirth as well as for the entire NICU hospitalization. Regression analyses adjusted for the impact of (i) maternal and infant characteristics and distress on maternal visitation rates and (ii) the impact of visitation on long-term maternal distress and rates of infant clinic attendance and rehospitalization. RESULTS: Greater number of children in the home, maternal exposure to a greater number of potentially traumatic events prior to childbirth and lower maternal anxiety consistently predicted lower visitation rate. Lower maternal visitation rate predicted higher maternal depression scores at infants' 4-month CA visit. Maternal NICU visitation rate did not predict post-NICU discharge infant clinic attendance or rehospitalization. CONCLUSION: Distress is an important predictor of visitation. In turn, visitation is associated with long-term maternal distress.

"I have faith in my milk": the meaning of milk for mothers of very low birth weight infants hospitalized in the neonatal intensive care unit.

BACKGROUND: Mothers who deliver a premature infant often choose to provide milk because it is the "one thing that only the mother can do" to optimize her infant's outcome, helps mothers feel a connection with their infants, and helps relieve the guilt associated with the preterm birth. OBJECTIVE: The purpose of this study was to describe the meaning of milk for mothers who are providing milk for their very low birth weight (VLBW; < 1500 g) infants hospitalized in the neonatal intensive care unit (NICU). METHODS: Using a qualitative descriptive design, in-depth semistructured interviews were conducted with 23 mothers of VLBW infants hospitalized in a level III NICU. Mothers were asked to share their perceptions about what providing milk meant to them. RESULTS: Mothers had faith in the healing properties of their milk and equated providing milk with "giving life" to their infants, mitigating the effects of complications, keeping their infants healthy and stable, and helping themselves address the feelings of failure and guilt associated with the premature birth. Mothers' faith in their milk to achieve these outcomes was a maternal motivator to continue pumping, even for mothers who had not intended to provide milk or who experienced the paradox of disliking pumping but wanting to provide their milk. CONCLUSION: The experiences of these mothers reflect the importance of acknowledging mothers' faith in the healing properties of their milk as a motivating factor for sustaining lactation while coping with the stress and anxiety inherent during the infant's NICU hospitalization.

Measuring participation in a prevention trial with parents of young children.

This paper describes parent participation in a clinical trial of preventive parent training (PT) targeting low-income parents of young children. Participation encompassed enrollment, attendance, and engagement. Average enrollment rate was 34.9%, although enrollment rates were significantly higher in the control (39.1%) than in the intervention (30.6%) centers. Parents attended an average of 39% of the PT sessions. Higher attendance was associated with lower parenting self-efficacy, more parent-reported child behavior problems, and attending the first PT session. Level of engagement in the PT sessions was related to improvements in parent and child outcomes. Findings suggest that attendance is linked to parent perceived need for help and that resources should be focused on ensuring parent attendance at the first intervention session.