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| ORIGINAL ARTICLE |
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| Year : 2018 | Volume
: 15
| Issue : 1 | Page : 33-38 |
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Knowledge of and attitude on assessment of substance use disorders of nurses working in general wards
Sumity Arora Tarafdar1, Sandhya Gupta2
1 Dept of Mental Health Nursing, Holy Family College of Nursing, Okhla, New Delhi, India
2 Dept of Mental Health Nursing, College of Nursing, AIIMS, New Delhi, India
| Date of Web Publication | 10-Jul-2019 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None  | 2 |
DOI: 10.4103/2231-1505.262503
Early detection of substance abuse disorders can facilitate treatment. Health care professional’s knowledge and attitudes can play a role in the failure to identify and address patients with substance use problems and may negatively influence the care that these patients receive. The objectives of the study were to assess the knowledge of nurses working in general wards regarding assessment of substance abuse in patients and their attitude towards patients withsubstance abuse. Method: A cross sectional study was conducted on 150 Nurses working in medical, surgical, emergency, ICU, pediatrics, obstetrics and gynecology wards of selected hospital of New Delhi, selected by simple random sampling method. A socio-demographic data was collected. Other Tools: A structured knowledge questionnaire and Attitude scale was used for assessing knowledge and attitude. Total knowledge score ranged from 0-16 and total attitude score ranged from0-75. Informed consent was taken prior to the data collection from the study subjects. Results: Mean knowledge score of subjects regarding substance use was 7.17 (with range of score as 1-13). One third of the subjects 32% (n=48) have inadequate knowledge, 58.66% (n=88) have average knowledge and 9.33% (n=44) have good knowledge regarding assessment of substance use disorder in patients. The unfavorable attitude was shown by 5.33% (n=8) of subjects and 94.66% (n=148) of subjects have favorable attitude towards patients with substance use disorders. Knowledge was significantly associated with attitude. The was no association of knowledge and attitude with selected demographic variable. Conclusion:The study findings suggest that majority of nurses need to attend educational and training programs for assessment of substance use disorders to participate in care planning of persons with substance use disorders.
Keywords: Knowledge about Substance use disorders, Attitude towards Substance usedisorders, Assessment of substance use disorders
How to cite this article:
Tarafdar SA, Gupta S. Knowledge of and attitude on assessment of substance use disorders of nurses working in general wards. Indian J Psy Nsg 2018;15:33-8 |
How to cite this URL:
Tarafdar SA, Gupta S. Knowledge of and attitude on assessment of substance use disorders of nurses working in general wards. Indian J Psy Nsg [serial online] 2018 [cited 2023 Jun 3];15:33-8. Available from: https://www.ijpn.in/text.asp?2018/15/1/33/262503 |
| Background Of The Study | |  |
National estimates ondrug-related visits to hospital emergency department are obtained from Drug Abuse Warning Network (DAWN). In 2011 according to DAWN, there were nearly 4.6 million drug-related emergency department visits nationwide in which there were 2.1 million drug abuse visits. It included 21.2% of the people involved in illicit drugs, 14.3% people involved in alcohol and 27.1% people involved in the non-medical use of pharmaceutical (prescription or OTC medication). The majority of drug-related emergency department visits were made by patients 21years or older[1].
Nurses provide 24 hours care to the patient in the hospital. The role of the nurse is very important in screening and managing the patient in general health care setting. Patient seeking detoxification or experiencing withdrawal visit general medical care setting before long-term mental health rehabilitation, thus Acute Care Medical Surgical Nurses have the first interaction with these patients in their setting[2]. The nurse is the one who encounters the patient first in an emergency condition, so they need a high level of clinical competences, expertise’s and skill to assess the substance use[3]. A positiveinitial nurse-patient relationship is part of creating a successful early response to treatment.
General practice nurses lack the knowledge of assessment of substance abuse and effect of addiction[4],[5]. As per the study of Owens L, Gilmore IT, Mohamed PM[6], 77% of the staff nurses lack in the knowledge of substance abuse. Early identification of the issues related to the abuse of psychoactive substances by nurses is a fundamental step towards the prevention, intervention and treatment activities. Primary health care facilities are responsible for screening for several health problems. The introduction of intervention in primary health care settings will help to reduce the problems of substance misuse before it reaches higher levels[3].
Negative attitudes have been found in a significant number of nursing population since the 1960s and 1970s, and although the proportion of nurses with pessimistic attitudes appeared to lessen throughout later decades, negative attitude still exist[7]. In the later years, the attitude of the nurses is inclining toward positive side. Brenda Happell revealed that the nurses show favorable and positive attitude towards substance abuse patients. Therefore, a baseline understanding of nurse’s attitude towards patient with substance abuse is required to improve the nurse patient relationship and the quality of care.
Thus, the present study aimed to assess the knowledge of nurses working in general medical and surgical wards regarding assessment of substance abuse among patients and their attitude towards patients with substance abuse in selected hospital of Delhi. Objectives of the study were: To assess knowledge of nurses regarding assessment of substance abuse in patients, to assess the attitude of nurses towards patients with substance abuse, to correlate the knowledge of nurses regarding assessment of substance use with their attitude and to find out the association of knowledge and attitude of nurses with their sociodemographic variables.
| Methodology | | |
It was a quantitative, descriptive, cross sectional study, conducted on 150 registered Nurses employed in medical, surgical, emergency, ICU, pediatrics, obstetrics and gynecology wards of selected hospital of New Delhi, selected by simple random sampling method. This hospital is a charitable missionary hospital and serves both rural and urban populations. Permission was obtained to conduct the study from the hospital. Informed consent was taken from the subjects to participate in the study. Inclusion criteria was: all the nurses who were registered in Delhi nursing council, working in selected hospital, willing to participate in the study were included. Socio demographic characteristics of sample was assessed which included age, qualification, area of work, experience, institution, experience in psychiatry, working experience with substance abuse clients etc.
| Research instruments | | |
A structured 16 item knowledge questionnaire was used to assess the knowledge of nurses regarding assessment of substance use. Participants responded to knowledge items by answering the best option. A 5-point LikertAttitude scale of nurses towards patients with substance abuse was used for responses to the attitude items. The interpretation of attitude was based upon the scoring, 15-45(Unfavourable attitude), 45-75(Favourable attitude). Content validity was ensured by 5 experts.Reliability of the adapted instrument was assessed by using a Kuder-Richardson test for the knowledge scale and Cronbach’s alpha for the attitude scale. Data was collected from the staff nurses working in respective areas. Time taken by one participant for filling the questionnaire was 20 minutes. Confidentiality was assured. SPSS version 20 was used to analyze the data. Descriptive and inferential statistics was used. Analysis of variance (ANOVA) and t tests were used to evaluate differences between selected demographic variables and knowledge and attitude scores.
| Results | | |
Demographic characteristics of Subjects
As shown in [Table 1]a, the sample consisted of 150 registered nurses, who ranged in age from 21 to 64 years. 86.66% of nursing staff (n=130) were 21-30 years of age. They were primarily female (n = 150)100%. Educationally, 18% (n=27) of the nurses carried a bachelor’s degree, 81.33% (n=122) were diploma prepared, and 0.66%(n=1) held a master’s degree. Of the sample, 30.66% (n=46) were employed in ICU, 19.33% (n=29) had been employed in medical wards, 7% (n=11) had been employed in emergency ward. Approximately half (42.66%, n=64) of the sample had been employed for more than 3 years. Almost 93.33% of the sample studied from private institution.
As shown in [Table 1]b, although, 67% (n=101) of the nurses had no experience of working in psychiatry ward, 44% (n=66) had experience of working with client with substance use. More than half (68%) of the nurses had not attended any seminar/ in-service education regarding screening of substance use. Almost 98.66% (n=148) of nursing staff were not aware about de-addiction Centre nearby their working place. Majority 82 % (n=123) of the nurses did not know about the treatment of substance use in their working place. Regarding the best time to provide comprehensive care, 66%(n=99) of nurses agree that hospital stay is the best time for nurses to provide comprehensive care for substance abuse and 88.66%(n=133) of nurses agreed that nurses should be involved in screening and management of substance abuse.
Almost 86% (n=129) of nurses regularly advice the patient to avoid the substance abuse,89.33%(n=134) of nurses routinely ask questions related to substance abuse during history collection, 94%(n=141) of the nurses expressed the need for education session for increasing the knowledge of nurses regarding substance abuse.
| Knowledge and attitude score | | |
As given in [Table 2] that, out of 150 subjects, on the knowledge scale, scores for the participants ranged from 0 to 16 (Mean=7.166). Higher scores indicated greater knowledge. Out of 32% (n=48) of nurses have poor knowledge, 58.66% (n=88) of nurses have average knowledge and 9.33% (n=44) of nurses have good knowledge regarding assessment of substance abuse on patients. [Figure 1] shows the area-wise knowledge score of nurses. Majority of the Nurses in the medical ward, surgical ward, emergency, ICU, pediatric ward, obstetrics and gynecology ward and other ward had average score in the knowledge regarding screening of substance use. | Table 2: Knowledge of nurses regarding assessment of substance abuse. (n=150)
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 | Figure 1: Bar diagram Showing percentage distribution of knowledge level of nurses in different area of work( medical), surgical, emergency, ICU, paediatrics, obstetrics and gynaecology and others)( n=150)
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As depicted in [Table 3] that on the attitude scale, scores ranged from 15 to 75 (Mean=50.26). Scores at the lower end of the scale indicated punitive, negative, unfavorable attitude. 5.33% (n=8) of nurses have unfavorable attitude and 94.66%(n=142) nurses have favorable attitude towards patients with substance abuse, as shown in [Table 4] the item wise distribution of attitude of nurses towards substance use. | Table 3: Frequency and distribution of attitude of nurses towards patients with substance abuse (n=150)
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 | Table 4: Frequency and percentage distribution of nurses by their response on unfavourable attitude statement (n=150)
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As shown in [Table 5], paired ‘t’ test was applied to compare the mean knowledge and attitude score. There was a significant difference in the scores for knowledge (M=7.17, SD= 2.52) and attitude score (M=15.27, SD=6.81); t(149)=-83.83, p =0.001.This shows that knowledge of nurses regarding assessment of substance use influence their attitude. This suggested that more is the favorable attitude more is the knowledge regarding assessment of substance use. | Table 5: Knowledge and Attitude Score of Staff Nurses regarding Substance Abuse
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To analyze differences between selected demographic variables and knowledge and attitude scores, ANOVA and ‘t’ tests were used. No significant differences were found among several demographic variables and knowledge and attitude scores of subjects. There was significant difference in the mean attitude score and qualification which showed more is the qualification higher is the favorable attitude of subjects. [Table 6], [Table 7] | Table 6 : ANOVA showing Association of knowledge score with selected demographic
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 | Table 7: ANOVA showing Association of attitude score with selected demographic variable
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| Discussion | | |
Nurses in the current study had average knowledge about assessment of substance use, which is contrary to the findings of Cynthia S. Selleck[5], where registered nurses demonstrated limited knowledge about substance exposure, addiction and its effects. This could be because, nursing education has taken a wider dimension and included substance use in the curriculum. The result of the present study is consistent with the study done by Sean K, Patrick K[9] to determine emergency department nurse’s knowledge regarding substance use and substance users, which revealed that 46% participant’s current level of knowledge about alcohol and drug misuse, in general, was satisfactory. Findings from the other studies[10],[11], are also consistent with the present study in which majority of the nurses had good knowledge regarding substance abuse.
Regarding attitude of nurses towards care of clients with substance abuse, the findings of the present study showed that nurses have favourable or positive attitude towards clients with substance abuse. This finding is contrary to the findings of other study[7] in which nurses demonstrated negative attitude. Chung, J., Changh, J., et.al[12] revealed that nurses working in local emergency rooms in Hong Kong exhibit negative attitude when working with alcoholic patients. The results of the present study is supported by Grafham et al[13] where it is reported that the culture of care for addiction is changing, with many nurses perceived substance misuse as more of illness than a moral weakness. Possible reasons for the positive attitude towards clients with substance abuse could be, growing acceptance of people with alcohol and other substance abuse problems, it could also be related to increase in nurses’ knowledge about typical, behavioural and cognitive causes of these conditions[14]. In the present study, majority (87%) of the nurses regularly advice the patients on avoidance of substance use, which is contrary to the study of Ducci, F.[14], in which they found that knowledge and skills gap existed in the delivery of effective advice on alcohol related issues, only one in two women and one in three men were receiving correct advice on sensible limits of alcohol consumption, despite the fact that alcohol histories are taken. Current efforts in the development of the drugs and alcohol work force recognize that education and training are one aspect of a wide range of factors that can influence nurse’s ability to care for patients with alcohol problems[15]. In the present study, there was no significant relation of knowledge and attitude of nurses with the socio-demographic variable which is similar to the results of Cynthia S. Selleck[5].
| Conclusion | | |
The study findings suggest that still there is lack of knowledge among nurses regarding assessment of substance use and there is a need to There is a need to maintain the favourable attitude. Thus, educational and training programs can be planned to motivate the general patients at the early stage of substance use. If early motivation and referral would be done, it would be beneficial for the patients, their family and country.
| References | | |
| 1. | Drug Abuse Warning Network, National Estimates of Drug- Related Emergency Department,2011.  |
| 2. | MelissaMN,Peter G,Paul D, Screening and managing cannabisuse: comparing GP ‘sand nurses’ knowledge, beliefs, and behaviour. Substance abuse treatment, prevention and policy2012:7(3). |
| 3. | Ford, Bemmer, and Brecker, Knowledge and attitude of nurses towards alcohol and related problems: and impact of the educational intervention, Journal of clinical nursing2009,(3) 2452-2462. |
| 4. | Owens, Varapon, Polit.S, Hungler C,Hussain M, Nurses knowledge regarding substance abuse and its identification among patients, Asian journal of nursing 2004,(2) 435-445. |
| 5. | Cynthia S, Selleck and Barbara. Knowledge and Attitudes of Registered Nurses Toward Perinatal Substance Abuse, Journal of Obstetric, Gynecologic, & Neonatal Nursing 1998,(27), page70-77. |
| 6. | Owens L, Gilmore IT, Mohamed PM, General practice nurses’ knowledge of alcohol use and misuse, an Internal journal of drug policy,2000,35(3): 259-262 |
| 7. | Howard, M.O., & Chung, S. S. Nurses attitudes toward substance misusers, 2000, Mental Health journal, Issue 5, 347-365. |
| 8. | Brenda Happell RN, Nurses knowledge , attitudes and beliefs regarding substance use, 2002, Nursing and Health science journal vol.4; page 193-200. |
| 9. | Sean Kelleher, Patrick Cotter, Substance abuse and misuse in general admissions. Jan 2009,International emergency nursing Vol. 17, Issue 1, pages 3-14 retived from www.pubmed.com |
| 10. | Maigari, b.Mosako,S.K., Umar, N.J. Kever, R.T. Dalhatu, A.Bathini, H.,. nurses knowledge & attitude towards the care of clients with substance abuse in Barno state. Journal of Nursing and health science 2014; 3; [19],[20],[21],[22],[23],[24]. |
| 11. | Goswami Y, JayalakshmiL. conducted a study to assess the Effectiveness of Structured Teaching Programme on Knowledge regarding Substance Abuse among staff nurses. |
| 12. | Chung J, Changh J, Yeung R, Wan R and Ho ST, Nurses attitude towards alcoholic patient in accident and emergency department, Hongkong,2003, Hongkong journal of emergency medicine, vol.10,104-112. |
| 13. | Grafham, K., Massak, A., Demer, A., &Rehm.,J. Specialist drug misuse nurses’ motivation, clinical decision making, and professional communication: an exploratory stud,2004,Journal of Psychiatric and Mental Health Nursing, 690-697. |
| 14. | Ducci, F. & Goldman, F.(2008). Journal on General approaches to addiction: genes and alcohol. Addiction, 2002, page 144-1428. |
| 15. | Roche and Pidd, Current effort in the development of drugs and alcohol workforce,2010, American Journal of Psychiatric, Vol.9,122-130. |
[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
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