Influence of Nurses Knowledge and Attitudes on Caring Behaviors for People with Opioid Use Disorder

BackgroundOpioid use disorder (OUD) remains the leading cause of preventable substance use-related deaths in the U.S. Each year, more than 1 million Americans seek hospital care for OUD-related issues. However, they often receive inadequate treatment and face barriers such as limited overdose prevention education, delays in medication initiation, and insufficient post-discharge follow-up. Nurses are well-positioned to improve inpatient OUD treatment, yet qualitative research suggests they often have limited knowledge and negative attitudes toward OUD, which can decrease the level of compassion and empathy nurses have toward people with OUD. Validated instruments, such as the Care Behavior Index (CBI-6) and Drug and Drug User Problems Perceptions Questionnaires (DDPPQ), can be used to assess the relationship between nurses knowledge and attitudes and the level of care nurses provide people with OUD. This study examined the relationship between nurses knowledge/attitudes and caring. Additionally, we further examined differences in DDPPQ and CBI-6 scores by nurses demographic and work-related factors. MethodA cross-sectional study was conducted from September 16th to December 10th, 2024 at two Tufts Medicine hospitals in Eastern Massachusetts. Approximately 600 nurses are employed in the adult inpatient units of these hospitals. Nurses were recruited through emails, newsletters, and targeted in-person outreach to nursing leadership. The survey was collected online via REDcap. Participants demographics, work-related factors, knowledge and attitudes (DDPPQ), and caring behaviors (CBI-6) were measured. Simple linear and generalized linear model regression analyses were conducted to examine the relationship between DDPPQ and CBI-6 scores, adjusting for relevant covariates. ResultsTwo hundred twenty-four nurses started the survey. A total of 125 nurses completed the entire survey and were included in the analysis (94% female, 82% white, 98% non-Hispanic, mean age 35 {+/-} 11.69) years). Nurses perceived knowledge and attitudes were significantly associated with caring behaviors ({beta} = -0.11, p < 0.0001), with higher DDPPQ scores (decreased knowledge and more negative attitudes) linked to reduced caring behaviors. Multiple workplace factors were associated with variations in nurses knowledge/attitudes and caring behaviors. However, holding an RN license was the only significant factor contributing to the relationship between knowledge/attitudes and caring. ConclusionNurses knowledge and attitudes play a crucial role in shaping their caring behaviors toward people with OUD. Although multiple workplace factors were associated with nurses knowledge/attitudes and caring. The possession of an RN license was the only significant workplace factor contributing to the relationship between knowledge/attitude deficits and reduced caring. Given persistent gaps in hospital-based care and the growing prevalence of OUD, there is an urgent need for targeted interventions at both individual and organizational levels to improve nurses knowledge and attitudes and support the delivery of evidence-based compassionate care for people with OUD. Further research should explore how specific workplace factors influence nurses knowledge, attitudes, and training needs related to the care of people with OUD.