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Section 2. Biomedical science
Ranyah Saeed Al-Ghamdi, Faculty of Nursing, Psychiatric and Mental health at College of Nursing King Abdul-Aziz University. Jeddah-Saudi Arabia
Prof. Nahed Morsy, Professor of Psychiatric and Mental health nursing, Faculty of Nursing, Psychiatric and Mental health at College of Nursing King Abdul-Aziz University. Jeddah-Saudi Arabia
E-mail: samialarsan@hotmail.com
NURSES' KNOWLEDGE ABOUT SUBSTANCE ABUSE AND WITHDRAWAL SYMPTOMS AMONG PATIENTS IN AL-AMAL HOSPITAL-JEDDAH
Abstract
Background: Substance abuse and withdrawal symptoms it is become a major health problem in different countries, affecting all levels of society, with possible irreversible consequences and could affect a person's relationships, educational opportunities, employment status, status in society, and general health and wellness. nurses' knowledge in this area is especially important.
Aim: To assess the level of nurses' knowledge about substance abuse and withdrawal symptoms among patient at al-Amal hospital in Jeddah.
Methods: A quantitative descriptive design was used in current study. A convenience sample of one hundred and forty-eight nurses were voluntary participate in the study.
Setting: the study carried out at Al-Amal hospital- Jeddah.
Tools: A self-structured questionnaire was used for data collection. This questionnaire assessed nurses' knowledge of substance abuse and withdrawal symptoms. Nurses' knowledge was examined by six items forced response agree/disagree and 17 items multiple-choice a graded across three grades of high level of knowledge from 16-23 average level of knowledge from 8-15 and low level of knowledge from 0-7.
Result: the result indicated that nurse's knowledge was an average level (70.47% SD ± 14.27). In contrast, the education level and departments had a statistically significant different with their knowledge.
Conclusion: The finding of present study showed that the nurses working in Al-Amal hospital held an average level of knowledge about substance abuse and withdrawal symptoms.
Recommendation: results of current knowledge surveys of nurses suggest that need for regular training and in-services education to provide the nurses skill and advanced knowledge to screen
the substance abuse and withdrawal symptoms and applied guideline for nursing management of detoxification and over dose.
Keywords: nurses' knowledge, substance abuse, withdrawal symptoms.
Introduction
The problem of substance abuse in the last decade of the twentieth century was exacerbated not only by economic, social and social complications but also by the high cost of primary prevention and secondary prevention programs and their failure to reduce the risk of addiction through the treatment of addicts [1]. Substance abuse it is become a major health problem in different countries, affecting all levels of society, with possible irreversible consequences. Substance abuse could affect a person's relationships, educational opportunities, employment status, status in society, and general health and wellness [2].
In 2013 was estimated that globally, 246 million people (1 out of 20) aged between 15 years and 64 years used an illicit drug, out of whom about 27 million people are problem drug users [3]. Furthermore, in Saudi Arabia, according to the National Commission for Drug Control, in 2014, there is increasing of substance abuse among Saudis and associated with many medical diseases, psychiatric disorders, and educational, occupational, social and legal consequences. Amphetamine, heroin, alcohol and cannabis were the most commonly abused among Saudi patients and the main risk factors were peer pressure and psychosocial stresses [1] On other hand, Over the past 10 years there is growing in awareness and attention regarding to the drugs abuse to be a parallel with the vision of 2030 in Saudi Arabia [4].
Substance abuse patient will be suffering from physical symptoms it is include withdrawal symptoms, which is caused by the negative response of the body to become without a substance and it's will be depended on the time of use. Withdrawal symptoms defines by the National Institute of Drug Abuse (NIDA) as a probable group of signs and symptoms will be result from the sudden stop of use or decrease
in the steady dosage of a drug. These signs and symptoms of withdrawal symptoms could be varied significantly from one drug to the others [5].
Nurses' knowledge about substance abuse and withdrawal symptoms can play a major role in the misdiagnosis patients with substance abuse problems [6]. Lack of nurses' knowledge about substance abuse and withdrawal symptoms is one of the barriers occur to nurses screening for patients with substance abuse problems, it can cause poor screening, misdiagnosis and low intervention [7]. On other hand, insufficient educational content regarding substance abuse in essential nursing curricula, and a considerable shortage ofprofessional education, continuing education, and training can cause inadequate nursing care for patient with substance abuse issues [8].
Methods:
A quantitative and descriptive research design has been adopted as a research design for this study. The study was conducted at Al-Amal hospital affiliated to Ministry of Health (MOH) in Jeddah city. a convenience of sampling method used to select the sample of 217 nurses whose give the direct patients care in Al-amal hospital. Tool of data collection was translated into Arabic language and a total of five expertise in nursing field reviewed the study tools. the internal consistency using Cronbach's alpha coefficients. Reliability of this study was 0.72 a pilot study was conducted on 10% of the study participants out of calculated sample size of 217 nurses. The pilot study conducted among 20 nurses from selected area according to the inclusion criteria after obtaining permission. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 22. Descriptive measurement. The data was collected by head nurses and only the researcher had access to data throughout the study. The research tool that used to collect data for the present study was a self-
administered. The structured questionnaire divided to two parts: Part I: Includes 11 items divided to two Sections: Section a: Socio - demographic details of the participants 6 items such as (Sex, Age, Nationality, Marital status, Educational level, Department). Section b: clinical experiences such as (Professional experience in al-Amal hospital, Professional experience in general hospital) and 7 Motivational statements to work with substance abuse patients. Part II: Includes 23 items divided to two Sections: Section a: 6 items forced response agree/disagree based on the work of Happell et al. [9] to assess the facts about drugs and alcohol use. Items number 2, 5 consider correct answer of respond by disagree. Section b: 17 items multiple-choice 7 items (5, 6, 7, 8, 9, 10, 11) based on the work of Happell et al. (8) and 10 items (1, 2, 3, 4, 12, 13, 14, 15, 16, 17) developed by the National Council Licensing Examination (NCLEX) to assess the Nurses' knowledge about substance abuse and withdrawal symptoms. Coding system for Nurses' knowledge about substance abuse and withdrawal symptoms.: True answer = 1, False answer = zero.
Finally, the total scores of correct answers were 23 and all items was computed and classified in as follows: high level of knowledge from 16-23 average level of knowledge from 8-15 and low level of knowledge from 0-7.
Two major principles were upheld to ensure the ethical validity of the study: Firstly, authorization of
the Ethics Review Committee of ethical committee in Faculty of nursing, King Abdul-Aziz University and committee in ministry of health (MOH) and al- Amal hospital was obtained. Secondly, informed consent of all participants in the study above was secured. All participants were assured of the confidentiality of data collected.
Result:
The total sample size for the study was 149 nurses. A large proportion of study participants age was between 31-40 years accounted for 63.1% and lowest was 51 years and more accounted for 4.7%. It is noteworthy that most of participants were primarily male and were married (79.9% & 80.5% respectively). As regarded the nationality 85% of participants were Saudi only 14.1% were non-Saudi. Regarding educational level sixty-three present of study sample has diploma degree while 34.2% achieved bachelor's degree in nursing and only 2.0% were master degree. Out of 149 nurses who participated. The highest participated (18.8%) from female ward and the lowest (5.4%) from ward M. In addition, thirty percent of study participate had more than two years' experience in general hospital and 26.2% had 6-9 years only 8.1% had more than 14 years of experience. About one third (32.9%) of participant had 6-9 years of experience in Al-Amal hospital and lowest percentage of the (6.7%) had more than 14 years as (Table 1).
Table 1.- Distribution of study participants according to their Socio-Demographic characteristics (n=149)
Socio-Demographic characteristics study participant(n = 149)
Frequency No. Percent (%)
1 2 3
Gender
Male 119 79.9%
Female 30 20.1%
Age
less than 30 years 43 28.9%
31-40 years 94 63.1%
41-50 years 5 3.4%
1 2 3
51 years and more 7 4.7%
Marital Status
Single 28 18.8%
Married 120 80.5%
Divorced 1 7%
Nationality
Saudi 128 85.9%
Non-Saudi 21 14.1%
Education
Master degree 3 2.0%
BNS degree 51 34.2%
Diploma degree 95 63.8%
Department
Male Ward A (detoxification security unit) 27 18.1%
Male Ward B (detoxification unit) 27 18.1%
Male Ward C, D (behaviors modification unit) 25 16.8%
Male Ward M (post-discharge continuous care unit) 3 5.4%
Male ER 19 12.8%
Male OPD 6 4.0%
Adolescent ward 9 6.0%
Female ward 28 18.8%
Most of the participants (75.5%) were attend training education or courses related to drug abuse & withdrawal symptoms. while thirty-eight reported that not attend the training related to drug abuse & withdrawal symptoms.
Regarding to the nurses' level of knowledge, the highest number of participants had an Average level of the Knowledge 105 participants. 28 of participants had a High level of the Knowledge. Only 16 had a Low level of the Knowledge. In addition, Overall Nurses' knowledge and total mean scores were 14.27 SD ± 3.11 as (Figure 1).
The analysis of variance one-way ANOVA was used to identify the statistically significant between Nurses' knowledge about substance abuse and withdrawal symptoms and their Socio-demographic characteristics.
levels of the Nurses* knowledge
■ High level ■ Average level ■ low level
Figure 1. levels of nurses' knowledge about substance abuse and withdrawal symptoms
The finding shows that nurses less than 30 years of old had the highest mean scores of13.35SD ± 2.64 and the nurses from 51 years and more had the lowest mean score. In addition, female participants had a mean score of 13.43 SD ± 2.62 higher than male participates. Regarding marital status, single nurses had the highest mean of13.11 SD± 4.99. Also, nurses with BNS degree mean scores was the highest with mean of 13.48 SD ± 3.62 and lowest score was belonged to nurse with Master's degree. Moreover, nurse who working in Male ER had a highest mean score of 15.95 SD ± 6.23 and lowest mean score from Male
Ward M (post-discharge continuous care unit). In addition, nurses with clinical experience in general hospital more than 2 years had the highest mean scores of 13.87 SD ± 4.08 and who had Professional experience in al-Amal hospital from 2-5 years. However, test revealed that there was no significant different between Nurses' knowledge about substance abuse and withdrawal symptoms and gender, age, marital status, Nationality and Professional experience in general hospital or AL-Amal Hospital. In contrast, the education level and departments had a significant different with their knowledge (p < 0.05) as (Table 2) indicated.
Table 2.- The relationship between Nurses' knowledge about substance abuse and withdrawal symptoms and their Socio-demographic characteristics (N = 149)
Socio-demographic Participants' knowledge about substance Test of significant
characteristics abuse and withdrawal symptoms (Sig.)
Mean ± SD T-value p-value
Gender
Male 12.72 SD ± 3.85 -1.199 0.235
Female 13.43SD ± 2.62
less than 30 years 13.35SD ± 2.64
31-40 years 12.66 SD ± 3.98 0.951 0.418
41-50 years 12.80 SD ± 4.87
51 years and more 11.00 SD ± 2.83
Marital Status
Single 13.11 SD ± 4.99
Married 12.75 SD ± 3.26 0.656 0.521
Divorced 9.00 SD ± 0.01
Nationality
Saudi 12.62 SD ± 3.77 -1.509 0.134
Non-Saudi 13.95 SD ± 2.84
Education
Master's degree 8.00 ±3.46
BNS degree 13.48±3.62 2.957 0.058*
Diploma degree 12.56±3.57
* relation is significant at the 0.05 level Discussion:
The result shows that nurses from different wards participated in the current study to answering the questionnaire to assess the level of nurse's knowledge about substance abuse and withdrawal symptoms. The
number of male participants were much higher than female participants. A possible explanation for this result might be the high ratio of male nurses comparing to female nurses. In addition, there are a seven male wards in the Al-Amal hospital and only one female ward and
it is not allowed for female staff to work with male patients regarding to the hospital policy. This result contradicted to many other results [10; 11] and [12], as they found that majority were female.
Likewise, about one third of study sample have clinical experience that ranged from six years to nine years. This result may be the majority of study participants were between 31-40 years of age. Similar result found by [10] and [11].
According to the nationality, the majority were Saudi. This result may due to governmental policy to maintain the patient privacy and confidentiality. In addition, nurses who working with substance abuse patients should have the same language to provide a good communication with patients and for educating them and their families about the risks of substance abuse and their treatment options.
In addition, a diversity of nurses with different background, more than half of the study participant belong to nurses with diploma degree. This result may be explained that nurses feel uncomfortable when working with people who are dependent on drug and held negative views about people who used drugs.
In addition, according to the overview of the implications of bachelor's degree nurse education in Saudi Arabia (SA) done by (Noura A., 2015) [13] reported that "the maj ority of nursing workforce was diploma holder".
As regards to the clinical experiences to study participants in the management of substance abuse patients in al-Amal hospital-Jeddah. One third of participant had 6-9 years of experience in Al-Amal hospital and more than half of the nurses had received formal training in substance abuse and withdrawal symptoms. This result may be that two third of the participants had a need to attend courses or training education about substance abuse and withdrawal symptoms to enhance their knowledge. This result similar to study finding by (Cameron,2006) and contraindicated with [14] Leonieke C. van Boekel, 2013), [15] (Rosmary, 2008) and [16] (CaraElizabeth, 2011) were find the more than half
of the sample had not received training in drug and alcohol issues.
Nurses knowledge about substance abuse and withdrawal symptoms in current study was examined by multiple-choice and forced response. The results revealed that the level of nurse's knowledge was ranged between a minimum and maximum ofcorrect response of 6-19. The finding of this study shows a high level of knowledge in diagnosis of substance abuse and withdrawal symptoms, management of alcohol use and average level in relation to signs and symptoms of substance abuse and withdrawal symptoms. In addition, the finding show that nurses demonstrate a very low level of knowledge in medication commonly used for patient with heroin and cannabis use symptoms. This result may be due to the participants had experiences in general hospital and Al-Amal hospital more than two years. In addition, the majority had training and motivated to work with substance abuse patients in Al-Amal hospital. The finding of the present study is contrary to the findings conducted by [17] (Maigari, B., 2014) in Nigeria to assess the nurses' knowledge and attitude towards substance abuse patient. They found out that "the total knowledge scores presented that 42.6% had good knowledge, 19.6% of nurses had very good knowledge, while 14.2% had poor knowledge".
The current study found no statically significant different between Nurses' knowledge about substance abuse and withdrawal symptoms and gender, age, marital status, Nationality and Professional experience in general hospital or AL-Amal Hospital. However, a statically significant relation was found between nurses' knowledge and education level and between nurses' knowledge and departments (p < 0.05). This finding agrees with [18] (Nedenleri, 2016) were found that all sociodemographic and professional characteristics of emergency nurses have no effect on nurses' perceptions about the substance abuse and withdrawal symptoms.
In current study a statically significant relation was found between nurses' knowledge and education level. Nurses who have a bachelor's degree
show a high level of knowledge with scores mean 13.48 ± 3.62. baccalaureate nursing programs offer 1 to 5 hours of alcohol and drug abuse content throughout their curriculum. This result was consist with [11] identified that "participants with some training in alcohol and drug abuse after their nursing education and/or who received some type ofprepa-ration for working with these health problems during their nursing education showed higher mean scores on the Knowledge questionnaire" and contradicted with [9] reported that "available knowledge on the fact that nurses' negative beliefs, values, and thoughts do not change even if they come across such patients and probably, they contact with the patients less".
Regarding to the relation between Nurses' knowledge and departments, nurses working in the emergency department show the high mean score. This result may be due to the nurses in emergency room frequently facing the patients with substance abuse issues and withdrawal symptoms and receiving their first intervention in this department.
Conclusion:
The main aim of this study was to assess the nurse's knowledge about substance abuse and withdrawal symptoms. To answer this question, descriptive design was used to assess the level of nurse's knowledge. The finding of present study showed that the nurses working in Al-Amal hospital held an average level of knowledge about substance abuse and withdrawal symptoms and had a significant relation to the education level and departments.
Recommendation:
The finding from current study suggest several actions must be undertaken include the following:
• Hospital administration should give the nurses opportunity to attend conference and
workshop regional or national regarding to substance abuse and withdrawal symptoms to ensure nurses awareness about substance and withdrawal management guideline and polices.
• Periodically assess the nurse's competence regarding substance abuse and withdrawal symptoms and motivate them on professional growth which influence their knowledge.
• Implement the clinical guidelines for withdrawal management and treatment of drug dependence in Al-Amal hospital.
• The result of current study should be share with stake holder at Jeddah to establish educational program for nurse in the area.
• Further investigation is required to examine the effect of education intervention on nurse's knowledge regarding to substance abuse and withdrawal symptoms in addiction setting in Saudi Arabia.
• Another possible area of future study would be to investigate the barrier affecting nurse's knowledge about substance abuse and withdrawal symptoms and identified a problem that rises on the job.
• Future research could further develop education program for nurses to provide Screening Brief Intervention and Referral to Treatment to substance abuse patients.
Acknowledgement:
I would like to express my honest gratitude to my advisor Prof. Nahed Morsy, professor of Psychiatric and Mental health nursing at King Abdul-Aziz University for the continuous support of my master study and related research, for her patience, motivation, and knowledge.
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