TRAINING NURSES TO SCREEN FOR AND PREVENT SUBSTANCE ABUSE: NURSES HELPING COLORADO
Background: SBIRT is an evidence-based package of public health interventions to address varying levels of risk for substance use disorders. However, health care professionals use these interventions rarely. Nurses play a critical role in fully integrating SBIRT services into a variety of healthcare settings. Nurses are well positioned to deliver SBIRT because of their extended patient contact and existing skills in health promotion, communication, and patient education, but additional training is necessary to give them the knowledge, attitudes, and skills needed for SBIRT. Evaluation data at the end of the first year of training suggest successes as well as gaps and areas for improvement.
Methods: In year 1, we trained 273 BS students and 196 APRN students in primary care specialties across the lifespan. Students were predominantly female and White, although there was some demographic diversity consistent with the population of Colorado. SBIRT training used a three-part approach, with didactic instruction threaded through multiple BS and APRN curriculum courses, simulation exercises linked to the course content, and supervised practicum experiences. Evaluation measures targeted each of these three components, and included trainee self-reports before and after training, behavioral observation measures of simulation exercises, and clinical chart documentation of APRN students’ practicum experiences.
Outcomes: Students reported high levels of satisfaction with the training in both curriculum levels – BS (82%) and APRN (85%). They reported similarly high levels of knowledge gain and intention to use SBIRT after training. Observational data for the first cohort of BS students trained showed high rates of screening (86%-95%) and moderate use of brief intervention skills (58%) in simulated patient encounters. A discrepancy between assessment and intervention was also seen among clinical preceptors, who said that they screen for substance use 65% of the time but offer brief interventions only 6% of the time. To date, clinical practice documentation has shown very low levels of SBIRT in actual practicum settings (<5% for all APRN specialties). A crucial gap appears to be preceptors not using or modeling SBIRT skills in practice.
Conclusions: Although BS and APRN students have been very receptive to SBIRT training as part of their regular coursework for a nursing degree, and are able to demonstrate SBIRT skills in simulated patient encounters, these skills are not being successfully implemented in practice settings. Training clinical preceptors is a key focus in year 2 of the training program, so that they can more effectively mentor students. Additionally, we are focusing on communication skills training to help students make the transition from asking about substance use to successful brief intervention.