Medical-surgical nurses’ experiences caring for patients with suspected opioid use disorder
Opioid use disorders (OUDs) are epidemic in the United States. Individuals with undisclosed OUDs are commonly encountered in general hospital settings. Many studies confirm negative attitudes of healthcare professionals towards patients with substance use disorders (SUDs), especially nurses. Current evidence suggests negative attitudes of healthcare professionals are associated with negative outcomes for this patient population. This qualitative study examined medical-surgical nurses’ experiences caring for patients with suspected OUDs. Study findings included that nurses could remember little or no content on SUDs from nursing curricula. It was through experiences caring for actual OUD patients that enabled nurses to identify patients who may have an OUD. Identification of those suspected of OUD was based on frequent and/or bogus admissions, identifying Dilaudid as the drug of choice, setting phone alarms for the next opiate dose, rating all pain as severe, patient behaviors suggesting little or no pain, and a range of negative behaviors. Attitudes towards suspected OUD patients were largely negative and based on acting out behaviors and disruption of unit routines. Nurses had mixed feelings over the patient’s report of pain versus behaviors and assessment findings suggesting little or no pain. Consequently, a common pain management strategy was limiting opiates. Additionally, nurse-patient relationships were limited and nonproductive at best. Nurses were discouraged from caring because they felt they were not making a difference in the underlying problem; furthermore, giving pain medications made them feel they were drug dealers rather than healers. Paradoxically, most nurses did not engage in actions that might have validated the underlying OUD and the development of a treatment plan. Facilitation of treatment or referral may have enhanced nurses’ self-esteem and improved the outcome for this patient population. Study recommendations included the addition or enhancement of content related to SUDs, especially OUDs, in nursing curricula and staff training in acute care settings. Care may be improved in hospital settings through collaboration with physicians and administration to reduce opiate prescribing and the establishment of brief screening, intervention and referral processes.