Helen K. Burns

Effects of Screening, Brief Intervention, and Referral to Treatment (SBIRT) Education and Training on Nursing Students’ Attitudes Toward Working With Patients Who Use Alcohol and Drugs

ABSTRACT Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) can reduce alcohol use and negative health outcomes in patients with risky substance use. However, negative attitudes that some health care professionals have toward patients who use substances are a barrier to implementing SBIRT. Methods: The University of Pittsburgh School of Nursing, in partnership with the Institute for Research, Education, and Training in Addictions (IRETA), developed a curriculum to train baccalaureate student nurses to deliver SBIRT. Results: Following SBIRT education and training, students’ perceived attitudes toward patients who use alcohol became more positive. Less robust changes were found for attitudes related to patients who use drugs. Conclusions: Nurses composing the largest group of healthcare workers are in key positions to screen, intervene, and provide education about substance use.

Reflection: An Essential Element of Evidence-based Practice

“The real voyage of discovery consists not in seeking new landscapes but in having new eyes.” Proust aptly describes the shift that emergency nurses need to make to incorporate evidence into everyday practice. ED patients have multiple complex needs occurring within a fast-paced environment, demanding much from emergency nurses. Effective evidence-based responses require nurses to hone their skills in developing relevant clinical questions, searching the literature, analyzing the best evidence, and taking action. The critical starting point is a well-developed clinical question. These questions often can be difficult to develop in the course of daily practice. Nurses need the time and ability to critically think about, or reflect on, their own practice in order to successfully develop relevant clinical questions. The question drives the learning in evidence-based practice (EBP). Questions are significant because they facilitate learning by building on the nurses’ clinical expertise and experience. In a recent interview, Edmondson defined learning as a cyclical ongoing process of action, reflection, and new action. The process can be temporary to meet an immediate practice need, or it can be a developmental approach to incorporating evidence into practice.2 Reflection is an essential part of this learning cycle. Furthermore, it plays an important part in developing a successful evidence-based approach to clinical practice. Reflection is the practitioner’s ability to be aware of, make sense of, and learn from daily emergency nursing practice, resulting in improved patient outcomes while increasing satisfaction with his or her own work. The intent of reflection is for the nurse to review a specific clinical interaction and determine if the interaction proceeded as planned. If not, why didn’t it? This conscious exploration enables the nurse to use his or her personal experience and knowledge to critique the interaction, seek relevant evidence, learn, and then apply this knowledge to future care interactions. The use of evidence in clinical practice becomes more meaningful by building on the nurse’s personal experience and expertise. Nurses perform pieces of the reflective process all the time but may not recognize them as such. Daily care delivery gives rise to all types of thoughts and questions as a patient’s needs are met: for example, “This did not work as planned; it always worked before; why didn’t it work this time?” These thoughts often are bypassed because of other demands and/or a lack of a systematic process to convert them into a learning opportunity and evidence application. As nurses medicate a patient for pain, they may wonder why this 76-year-old woman is requiring so much pain medication when she is otherwise healthy. Or, as a male nurse explains everything he does to an unconscious trauma patient, he thinks, “I have been doing this for years; is there any proof this is beneficial to my patients?” Frequently, the thought goes no further, or it may take the shape of, “I remember reading something about pain and some individuals not responding to narcotics well; I will look that up later.” However, later often never comes because of busy practice demands or a lack of a process for reflection. Reflection may appear intimidating, complex, and abstract, especially to a busy practitioner. On further examination, however, it can be a rich experience. Reflection provides the emergency nurse with the opportunity to use research findings, personal experience, daily practice conditions, and presenting patients’ needs as an opportunity to improve practice and quality of care. Reflection can become the foundation for effective questioning of standard practice. Reflection incorporates a 3-step cyclical process. It consists of (1) an awareness that something is not as it should be; (2) critically thinking about what is happening or what happened in the context of the nurse’s thoughts, feelings, expert knowledge, and experiences; and (3) developing a new perspective to apply in future Debra N. Thompson is a PhD Student, University of Pittsburgh School of Nursing, Pittsburgh, Pa.

Technology and the nurse educator: are you ELITE?

Faced with an increasingly varied technology environment, nurse faculty and students often see the value of technology but struggle with its effective use. To address this issue, our school of nursing created an innovative program that provided faculty with tools and training needed to effectively implement educational technology. The authors discuss program content, implementation strategies, and results.

Overcoming barriers in online workshop development: an ELITE experience.

The Emerging Learning and Integrated Technologies Education (ELITE) Faculty Development Program created eight online workshops to assist nurse educators in using technology within their organizations nurse education program. Continuing education units were provided for completion of the individual online workshops. The ELITE program worked through several barriers to transform content that was previously presented during face-to-face workshops into standalone online offerings. Barriers and implementation strategies for the on-site to online transition included restructuring workshop objectives, keeping current with rapid technology changes, altering a course management system to meet the needs of the program and the learner, and crafting independent practice opportunities for the online learner. The online workshop development experience of the ELITE program may assist other continuing education and staff development professionals who are updating their program offerings or pursuing online education for the first time.

Using Research Findings to Design an Evidence-Based Practice Curriculum

Evidence from a system-wide research study highlighted strengths and weaknesses in evidence-based practice (EBP) implementation, beliefs, and organizational readiness. To address this evidence, a curriculum was developed within the context of the shared governance and EBP models for nursing practice. The curriculum, Evidence-Based Practice: Clinical Applications in Professional Nursing Practice, consists of five modules that provide the knowledge, skills, and abilities relative to each step of EBP. The learning approach incorporates classroom- and unit-based education, facilitated by EBP curriculum mentors. Each module is rolled out quarterly for a 15-month curriculum cycle. Outcome data include pre- and post-learning assessments, in addition to EBP projects. This seamless approach to nursing education, based on research findings and established shared governance and EBP models, can be undertaken by community hospital systems. J Contin Nurs Educ. 2017;48(4):184-189.

Using high-fidelity simulation as a teaching strategy with Baby Boomers returning to the RN workforce.

As a result of a changing economy, many Baby Boomer nurses are returning to the workforce. Common teaching strategies used in schools of nursing, such as high-fidelity simulation, are unfamiliar to this group of learners. Educators must learn not only the characteristics of Baby Boomer returning nurses but also how to adapt simulation to their learning styles.