Date Available

4-30-2025

Year of Publication

2025

Document Type

DNP Project

Degree Name

Doctor of Nursing Practice

College

Nursing

Department/School/Program

Nursing

Faculty

Dr. Holly Chitwood

Committee Member

Dr. Brandy Mathews

Faculty

Dr. Angela Hensley

Abstract

Background: Stigma towards substance use has been identified as a contributor to poor care and health outcomes amongst people who use drugs (PWUD), a vulnerable population. Healthcare worker stigma negatively affects the outcomes of individual patients and may have greater public health implications. Methods of addressing drug-use stigma have previously been implemented in a variety of clinical settings. Presenting the lived experience of PWUD to healthcare workers via emotionally compelling narratives has been found to be an effective means of stigma reduction.

Purpose: This study utilized two psychometrically validated tools to measure (1) the baseline prevalence of drug use stigma as reported by adult inpatients with a history of substance use or who were actively using drugs prior to admission, and (2) the efficacy of an intervention designed to reduce drug use stigma amongst healthcare staff. The effect on patient outcomes was examined through retrospective analysis of patient experience scores.

Methods: Narrative vignettes of PWUD were incorporated within an educational campaign targeting healthcare workers with direct patient contact on a single adult medical-surgical unit at the University of Kentucky (UKHC). Baseline prevalence of stigma was measured in a sample of 20 inpatients with a history of SUD during in-person interviews. Objective evidence of stigma was measured separately in a sample of 20 HCWs via pre- and post-interventional surveys. Select patient items of the Press Ganey – HCAHPS patient experience survey were examined to contextualize observed findings within unit-wide patient outcomes.

Results: For part one, inpatients reported moderate to high levels of drug use stigma on anonymous pre-interventional surveys. For part two, a statistically significant reduction in post-interventional stigma scores was observed. For part three, select Hospital Consumer Assessment HCAHPS patient experience scores decreased in the post-intervention period.

Conclusions: This study demonstrates that drug use stigma may currently affect some inpatients at UKHC. Results suggest that healthcare worker education incorporating narrative vignettes may be a useful method to reduce the likelihood that patients with a history of substance use will encounter drug use stigma while hospitalized. Additionally, tools used in the study may have utility in ongoing surveillance or subsequent investigations of drug use stigma. Patient experience HCAHPS scores were not positively affected by study interventions.

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