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RRP 09-164 – HSR&D Study

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RRP 09-164
Implementing a Nurse Training Program for Alcohol Screening and Intervention in Inpatient Medical Settings
Lauren M. Broyles PhD RN
VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
Pittsburgh, PA
Funding Period: February 2010 - February 2011

BACKGROUND/RATIONALE:
VA/DoD Substance Use Disorders Clinical Practice Guidelines recommend routine alcohol screening, brief intervention, and referral to treatment (SBIRT) for identifying and addressing alcohol misuse (the spectrum of use from hazardous drinking to alcohol abuse/dependence). Additionally, the Joint Commission has proposed new hospital accreditation measures regarding alcohol and tobacco SBIRT for all hospitalized patients. However, most healthcare providers have had no training in SBIRT techniques. Existing trainings have been primarily developed for primary care physicians, but differences in scopes of practice, role perceptions, and care delivery suggest the need to tailor training for nurses and the inpatient setting.

OBJECTIVE(S):
The aims of this pilot study were to (1) design an SBIRT training program for inpatient nurses, (2) perform a formative evaluation of training implementation, and (3) evaluate training effects on knowledge, attitudes, and clinical behavior.

METHODS:
This study used a hybrid quasi-experimental approach to evaluate training implementation and effectiveness. Two medical-surgical units were randomized to receive SBIRT training or self-directed website review. All registered staff nurses on the two units were eligible for study participation. Training consisted of a 2-hour didactic session and 30-minute booster session. Alcohol-related knowledge, attitudes, and clinical behavior were assessed with an enhanced version of the Alcohol and Alcohol Problems Perceptions Questionnaire (AAPPQ) which also measured reported frequency of and competence in performing 11 alcohol-related care tasks. Random effects generalized least squares regression models were used to examine the differences in AAPPQ subscale scores by unit over time. Chi square tests of trend were used to assess differences in changes in knowledge and in frequency/competence in performing alcohol-related care tasks between units. We also performed a formative evaluation of training implementation.

FINDINGS/RESULTS:
Twenty-eight and nineteen nurses completed baseline and time 2 assessments, respectively. Compared to nurses on the control unit, nurses on the experimental unit had significant increases in Role Adequacy (knowledge and skills) (p=.032), and a trend towards increased Role Legitimacy (perceived right/responsibility) for working with drinkers) (p=.14). No significant changes were detected in Role Support, Motivation, Satisfaction, or Task-specific Self Esteem in working with drinkers by unit. Compared to nurses on the control unit, nurses on the experimental unit had a greater number of alcohol-related care tasks that increased in reported frequency of performance (p=.011), and a greater number of tasks for which they indicated increases in competence (p=.001). Nurses identified role playing activities and pocket guides as curriculum strengths. Administrators appreciated the novelty of the harm-reduction approach and the tailoring of the training to inpatients and inpatient nursing practice. Both groups identified scheduling nurses to attend the live training/booster sessions as the primary barrier to training implementation.

IMPACT:
Effective SBIRT training for nurses can increase the number and scope of VA healthcare professionals who are prepared to address alcohol misuse with inpatients. Future efficacy and hybrid implementation trials of nurse-delivered SBIRT for hospitalized patients have been proposed within this program of research.

PUBLICATIONS:

Journal Articles

  1. Broyles LM, Kraemer KL, Kengor C, Gordon AJ. A tailored curriculum of alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) for nurses in inpatient settings. Journal of addictions nursing. 2013 Jul 1; 24(3):130-141.
  2. Broyles LM, Gordon AJ, Rodriguez KL, Hanusa BH, Kengor C, Kraemer KL. Evaluation of a pilot training program in alcohol screening, brief intervention, and referral to treatment for nurses in inpatient settings. Journal of addictions nursing. 2013 Jan 1; 24(1):8-19.
Conference Presentations

  1. Childers JW, Gordon AJ, Kraemer K, McNeil MA, Conigliaro JC, Broyles LM, Spagnoletti CL. Infusing SBIRT into faculty teaching – a model faculty training to acquire SBIRT awareness, knowledge, and skills. Paper presented at: Association for Medical Education and Research in Substance Abuse Annual Meeting; 2010 Nov 5; Bethesda, MD.


DRA: Substance Abuse and Addiction
DRE: Diagnosis
Keywords: Alcohol, Nursing, QUERI Implementation, Screening
MeSH Terms: none

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