Factors associated with nurses' professional readiness to provide alcohol-related care for medical inpatients

Broyles LM, Hanusa BH, Luther JF, Gordon AJ. Factors associated with nurses' professional readiness to provide alcohol-related care for medical inpatients. Paper presented at: International Network on Brief Interventions for Alcohol Problems Annual Conference; 2010 Sep 10; Gothenburg, Sweden.

Introduction: While hazardous alcohol consumption and alcohol use disorders are common among hospital inpatients, routine alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) are infrequently performed in hospital settings, thus leaving unhealthy alcohol use under-detected and under-managed among hospitalized inpatients. The inpatient general medical setting may provide an ideal opportunity for alcohol-related health promotion and intervention led by nurses. However, the extent to which inpatient nurses within the United States Veterans Health Administration (VHA) feel professionally prepared to conduct alcohol screening and intervention in this clinical context is unknown. Objective: The purpose of this study was to assess VHA nurses' readiness to screen and intervene for unhealthy alcohol use among hospitalized inpatients. Methods: In order to assess VHA inpatient nurses' professional readiness to screen and intervene for alcohol misuse, we conducted an anonymous mailed survey of 368 registered nurses (RNs) across 15 inpatient units at a large VHA medical center using an enhanced version of the Alcohol and Alcohol Problems Perceptions Questionnaire AAPPQ). Descriptive statistics were used to characterize the sociodemographic characteristics and alcohol-related knowledge, attitudes, and clinical practice of the sample. Descriptive statistics were also used in order to describe professional readiness to work with drinkers as reflected by the six AAPPQ subscales: Role Adequacy, Role Legitimacy, Role Support, Motivation, Satisfaction, and Task-Specific Self-esteem. We used Pearson and Spearman correlation, t-tests, chi square, Tukey-Kramer, ANOVA, and Kruskal-Wallis tests, as appropriate, to test the bivariate relationships between AAPPQ subscale scores and various sociodemographic, knowledge, attitudinal and clinical practice factors. Results: The 134 responding RNs were 77% female, 81% Caucasian, and 50% prepared with Bachelor's degrees, with an average of 13 years experience as an RN. Nurses across clinical subspecialties (Medical-Surgical, Critical Care, Psychiatry, and Short Stay Surgery) perceive alcohol use disorders to be prevalent among inpatients and primarily perform alcohol-related care tasks associated with screening and acute withdrawal management. Nurses also report the least amount of professional competence in alcohol-related care tasks such as assessing and discussing readiness to change drinking behavior, and referring patients to treatment or self-help programs. Several factors were significantly associated with mean scores on the six AAPPQ subscales: years as an RN; years of RN experience within the VHA; alcohol-related knowledge; receipt of alcohol-related continuing education; use of certain consult services; prior mental health experience; and clinical subspecialty. Years as an RN was inversely associated with Motivation (r = - 0.29, p < .05) and Satisfaction (r = - 0.19, p < .05) for working with drinkers. Similarly, years as an RN within the VHA was inversely associated with Motivation (r = - 0.33), Task-specific Self-esteem (r = - 0.24), Role Adequacy (r = - 0.20), and Satisfaction (r = -0.19) for working with drinkers (all p < .05). Psychiatric nurses had significantly greater Motivation and Satisfaction for working with drinkers compared to nurses from other subspecialties. Discussion: Across subspecialties, inpatient care nurses perceive alcohol use disorders to be prevalent among their patients, but their knowledge about alcohol and readiness to perform particular alcohol-related care tasks, particularly those related to brief intervention and referral to treatment, are limited. Results identify specific areas for nurse continuing education/training and the development of nurse champions in order to support inter-disciplinary approaches to addressing alcohol misuse. Results also help position U.S. hospitals for responding to hospital accreditation measures under consideration by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), measures which would require alcohol and tobacco SBIRT for all hospital inpatients.