Targets for change in alcohol and drug education for nursing roles

Alcohol Health & Research World,  Wntr, 1989  by Madeline A. Naegle

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Targets for Change in Alcohol and Drug Education for Nursing Roles

To provide services responsive to society's health care needs, nursing activities and nursing roles must adapt to changes in health needs and treatment trends. During the past decade, the use and abuse of alcohol and other drugs, especially cocaine, have risen dramatically and have spawned major health and social problems. While all health professionals encounter clients with drug-related health and medical problems, nurses, as the largest group of health care providers, have the greatest contact with clients and patients in the widest variety of settings.

Unfortunately, education has not kept pace with these new issues, and most nurses daily confront deficits in their understanding of alcohol and other drug abuse. Although consistent, progress has been slow in the three active components of the alcohol and other drug abuse education considered essential to advancing professionalism in nursing: (1) changes in attitude, (2) acquisition of information, and (3) development of skills.

THE NEED TO INSTILL ATTITUDINAL CHANGE

The need for a positive attitude toward patients with alcohol and other drug abuse problems is related to the philosophic underpinnings of nursing as a profession. From the time of Florence Nightingale, nursing interventions have been directed toward returning the patient to functions carried out in a daily routine of work, human relationships, health, and emotional well-being that the individual sees as desirable and as distinctly her or his own.

In general, recent surveys of nurses and other health professionals have indicated negative attitudes toward alcoholics and drug addicts and the prevalence of pessimism about successful treatment outcomes for addictions. A recurrent tendency to stereotype addicts as Bowery bums or junkies suggests that health care providers identify extreme cases and tend not to see degrees and patterns of use including their own.

Such negative attitudes compromise opportunities to increase learning and clinical skills. Burton (1971), Ewing (1971), and others stress that faculty and student attitudes about alcoholics and drug abusers determine their willingness to learn about diseases of addiction and ability to interact successfully with clients and patients. As role models to future health professionals, faculty who are knowledgeable on and experienced with the care of individuals with alcohol and other drug problems can make such care a visible, integral part of provider-client relationships. The relatively small number of nursing faculty educated in alcohol and other drug abuse, however, limits students' exposure to the expanding knowledge base in this area of practice.

A recent survey of 1,024 nurses (Sullivan and Hale 1987) suggests that attitudes about alcoholism are moving toward increased acceptance of psychological and physical-genetic aspects of the disease and away from moralistic views and the rejection of individuals with alcohol-related problems. Because the educational history of the survey respondents was poorly correlated with this shift in attitudes, the investigators credit changes in the general social climate with being the most influential factor in the positive trend they found in opinions about alcoholism and other alcohol-related problems.

Modest progress in attitudinal change is paralleled by curriculum changes in schools of nursing. In a survey conducted by Hoffman and Heinemann (1987), one-third of the responding schools of nursing reported that alcohol and/or drug content was included in their curriculums for medical-surgical, psychiatric-mental health, and community nursing. While content hours were limited (3 to 5 hours), the trend is consistent with that documented by Carter (1983): more frequent inclusion of drug or alcohol content at baccalaureate and master's degree levels. (Heinemann and Hoffman further discuss their survey results in this issue on pp. 48-51.)

NURSING KNOWLEDGE AND SCIENTIFIC TRENDS

Although the educational preparations of physicians and nurses are similar in the integration of basic science, they differ in the types, sources, and depth of knowledge acquired and in the practical application of that knowledge. The broader perspective of nursing allows an emphasis on caring that is directed toward patterns of human responses to illness and toward a greater application of knowledge from the social sciences -- e.g., psychological stress and its relation to health and illness care.

When new knowledge is generated by research in the basic biological and social sciences, its value to nursing practice derives from its relevance to theoretical and philosophical bases of nursing. Such knowledge is used in care delivery in accord with the educational preparation of the nurse and the role the nurse enacts in health care. New approaches to treatment for the dysfunctional family, for example, are implemented by the nurse counselor with advanced education.