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Confronting the Opioid Crisis
Nursing colleges add
curricula to deal with a growing public health problem
By Grace Bird, Inside Higher Education
April 11, 2018
Nurses are on the front lines of the opioid epidemic. As the first
faces many patients see, nurses have the opportunity to identify
individuals who are addicted, and they can also save lives by
administering naloxone, an "opioid antagonist" that reverses the
effects of an overdose.
But many nursing colleges are only relatively recently adding programs
about preventing and treating opioid addiction.
Deborah Finnell, associate professor in the department of acute and
chronic care at Johns Hopkins University's School of Nursing, said that
since she arrived at Hopkins about five years ago, she’s made a
concerted effort to push for more instruction on substance use, which
she said is lacking in nursing programs across the country.
Finnell co-authored a report published by Nurse Educator last year that
said nursing programs lacked curricula on substance use disorders, and
offered ways to remedy this problem. The emergence of the opioid crisis
has emphasized the need to better inform nursing students about
addiction, the report says.
“Nursing curricula have not kept pace with the growing public health
crises related to alcohol and other drug use and the expanding evidence
base for treatments,” the report states, adding that curricula on
addiction haven't changed much in four decades.
Nurses have an important role in combating the opioid epidemic because
they can intervene before an addiction spirals, the report says.
New Courses Trickle In
Over the past year or so, a number of nursing schools have introduced
programs to teach students to prevent and treat an opioid addiction or
overdose.
At the University of Pennsylvania Nursing School, starting this fall,
the nursing program will offer an undergraduate elective, Opioids: From
Receptors to Epidemic, which includes a lecture on overdoses, according
to Peggy Compton, an associate professor, who will co-teach the class
with Heath Schmidt. The course covers acute and chronic pain, the
composition of opioids, the pathophysiology of opioid addiction,
treatment options, the historical foundations of the crisis, and
current policies regulating opioid distribution. While the class is
geared toward nursing students, it's open to all majors “because the
implications go beyond health care,” Compton said via email.
Penn is also in the midst of developing two simulation programs -- one
in person, and one via virtual reality. In February, Penn piloted a
two-hour in-person simulation for nursing students. In the session,
actors mimicked the symptoms of an opioid overdose, as well as
overdoses of heroin and fentanyl, which are more potent versions of
prescription opioids (many times, opioid users will switch to heroin or
fentanyl if their prescription is not renewed). Students were able to
practice treating these patients, including dealing with their
reactions, which run the gamut from anger to distress to fear,
according to Ann Marie Hoyt-Brennen, Penn’s simulation education
specialist. The pilot was deemed a success and starting this summer
will be a requirement in two courses, one graduate and one
undergraduate.
A February 2017 study by the National Bureau of Economic Research found
that when states increased access to naloxone, opioid fatalities
declined by 9 to 11 percent. Despite this, naloxone has received some
negative press: critics say the opioid antagonist encourages addicts to
use again. Because of this perception, said Clare Whitney, a Ph.D.
candidate in Penn's school of nursing, many nurses are not aware of the
medication or do not know how to administer it.
“This is a really problematic narrative,” Whitney said. “The problem is
not that we have a drug that can save a life. The problem is that we
don’t have proper care.”
Marymount University will also pilot an opioid-related simulation this
month for 90 students in the health department, including the nursing
program. Catherine Hillberry, director of the college's nursing lab,
will show students a video of an opioid overdose and follow up with a
discussion on treatment and prevention strategies. Nurses need to learn
to work as a team with other medical professionals, Hillberry said.
"We don't work in silos, we work with other people, so we have to know
how to talk to other people, how to interact with them," Hillberry said.
The University of Cincinnati Nursing School started reviewing its
curricula on addiction a year ago after joining 190 other American
Association of Colleges of Nursing members in an agreement to teach
advanced-practice nurses about the Centers for Disease Control and
Prevention's "Guidelines for Prescribing Opioids for Chronic Pain,"
released in 2016. In response, Sherry Donaworth, associate professor of
clinical nursing at Cincinnati, wove the guidelines into the college
curriculum. Donaworth now requires her advanced-practice nursing
students to take three hours, in addition to the usual six, of
instruction on prescribing opioids. "Providers have an obligation to
prescribe in a way that doesn't perpetuate the problem," Donaworth
wrote in a blog post.
Some community colleges are also focusing on the opioid epidemic, too.
At Washington State Community College, in Ohio, Alicia Warren, director
and associate professor of practical nursing education, said the
nursing department recently introduced more information on opioid use.
In June, faculty members were urged to take a four-hour course called
Understanding Substance Use Disorder in Nursing, offered by the
National Council of State of Boards of Nursing. This semester, students
were required to watch a short video released by the board called
"Substance Use Disorder in Nursing" and take part in discussions on
opioid addiction in introductory and ethics courses. Students are also
taught to administer naloxone, which is becoming increasingly
accessible, Warren said.
Overcoming Stigma
Many nursing instructors cite stigma as a key challenge. To Craig
Sellers, director of the master’s program at the University of
Rochester School of Nursing, subverting perceptions of addiction begins
with language.
“We know that addiction is a health-care problem. It’s not about a lack
of character, if you will,” Sellers said. “We really try to avoid the
term ‘addict.’”
Stephen Strobbe, clinical associate professor at the University of
Michigan, echoed Sellers’s point, cautioning against using the word
“abuse.”
“The term ‘abuse’ has fallen out of vogue in our field, and is now seen
as negative, judgmental and pejorative,” Strobbe said.
Cincinnati recently started offering nursing students a presentation
about the neurobiology of addiction, aiming to subvert negative
attitudes tied to substance use disorder. Jennifer Lanzillotta, a
clinical nursing instructor, created the session, which includes
firsthand accounts from clinicians who became addicted to opioids
themselves -- an issue that isn’t unusual in the medical profession.
Lanzillotta is surveying students before and after the course to
determine how their perception of addiction shifted after viewing the
presentation.
“No one wakes up and says, ‘I want to be a drug addict,’” Lanzillotta
wrote in a blog post. “This presentation has shown we can reduce the
stigma associated with drug abuse by health-care providers.”
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