Purdue Nursing amplifies substance use disorder education through free online course content

By Tim Brouk, tbrouk@purdue.edu

Karen Foli

Karen FoliBrian Powell

While the COVID-19 pandemic raged across the globe, a dangerous U.S. epidemic rose steadily. According to The Washington Post, deaths from drug overdoses climbed almost 30% nationwide in 2020 compared to 2019. Deaths from opioids — primarily from illegal fentanyl — increased by 37% in the same time period.

The reasons for the dramatic increase in substance use are many, but from the perspectives of healthcare workers, it’s not about why but rather how to recognize substance use in the clinical setting and how to best treat it. To help with the pressing need to treat patients suffering from substance use disorders, faculty members in the Purdue University School of Nursing created the Massive Open Online Course (MOOC), Nurses’ Substance Use Education. MOOCs are free online courses open to anyone with unlimited participation.

“We know, in the general population, substance use has increased dramatically during the pandemic,” said Karen Foli, associate professor of nursing and project director/principal investigator and co-creator of the Nurses’ Substance Use Education MOOC. “So, nurses and caregivers will be interfacing with these individuals who are struggling with this chronic disease.”

Among the modules are video lectures, quizzes, writing assignments, discussion topics and animated avatar case studies that put nursing students of any level in real-life situations treating patients suffering from substance use disorders.

The MOOC was funded by a practitioner education grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), and the online course is available now for use. Foli said the entire suite of digital content could be used by any nursing educator, but with nursing curriculum as packed as it is, she expects certain modules, quizzes or lectures will be plucked from the site and integrated into preexisting coursework. The content is designed for all levels, from two-year registered nurse programs to Doctor of Nursing Practice curriculums. It can also be used by healthcare administrators to bolster education for their staff.

“We designed it for instructors to come in, select content and seamlessly integrate different pieces of the MOOC into existing curriculum,” Foli said.

Since its launch in May, the MOOC has been placed on its Addiction Technology Transfer Center Network site by SAMSHA. Other schools of nursing, such as Duke University, Ivy Tech Community College, University of Indianapolis and University of Southern Indiana, have pledged to share the content with their faculty. Foli and her team will present their MOOC work at the American Psychiatric Nurses Association annual conference in October.

From early morning meetings to potentially saving lives

While developing the Nurses’ Substance Use Education MOOC, Foli led meetings at 8 a.m. every Thursday during the height of the COVID-19 pandemic. Joining her were faculty from the School of Nursing as well as Wanju Huang, clinical assistant professor of learning design and technology in the Purdue College of Education, and Mohammad Shams Duha, doctoral student in Purdue College of Education; Carol Ott, clinical professor of pharmacy practice in the College of Pharmacy; and Lisa Kirkham, evaluation expert and research associate at the Evaluation and Learning Research Center. Team members were a constellation of expertise in substance use disorders, online learning, and process/summative evaluation, each dedicated to bettering humanity through education. This all-star team integrated their knowledge into several modules explaining why substance use disorder is a chronic disease, how crucial bedside interviewing and screenings of patients with histories of substance use are, and substance use in the nursing community.

Nicole Adams, clinical assistant professor of nursing, has a research focus on opioids and substance use. Her work is community-focused, and contributing to the Nurses’ Substance Use Education MOOC was important for her. She was especially proud of the animated avatar case studies found in most modules, which were developed in collaboration with Huang. Huang’s strong technological and online-learning expertise was paired with expert substance use-related content to construct the avatars.

“I love how it turned out,” Adams said. “They’re short, so they don’t drag on forever, but they are impactful in seeing how does this actually play out? It’s interesting to watch.”

During her 15 years as an ICU nurse in Indiana and New Mexico, Adams remembered a time when patients with substance use disorders were misunderstood and even misdiagnosed. For example, a case study in the MOOC describes a real-life instance where an older woman’s symptoms were misinterpreted as dementia, but it was actually prescription opioid withdrawal.

“For the undergraduates, we really focused on what you need to think of when assessing your patients,” she added. “We focused on really understanding why people have substance use disorder and why they develop those disorders.”

Becky Good, clinical associate professor of nursing, said substance use disorder should be clinically treated like diabetes or heart disease. Substance use is a chronic disease in some patients, who could be genetically predisposed to use drugs or alcohol. They do not choose to use as a lifestyle choice.

“We need to make it a part of a normal assessment,” explained Good, who also contributed content to the MOOC. “We can’t disregard the mental health of a person.”

Susan Kersey, clinical assistant professor of nursing, also contributed substantially to the MOOC. Her psychiatric mental health nursing background supported the advanced practice modules, especially the avatar case studies. In two progressive case studies, Kersey brings the learner to understand the importance of an individual’s readiness to manage their substance use and accept help.

Decrease the stigma

Much of the MOOC talks about the mental aspects of substance use. The stigma surrounding substance use is one of the most important hurdles nurses must face. Patients may experience tremendous amounts of guilt and shame, therefore skewing clinical interviews and treatments.

“It’s that awareness to look for things in different populations, including adults and older adults, that usurps the stigma and stereotypes we have of people who use substances,” Foli said. “We really want nurses to have a more informed approach and a trauma-informed lens when it comes to the issue of substance use.”

A better understanding of the patient’s disease progression along with recognizing physical ailments from substance use are key goals within the Nurses’ Substance Use Education MOOC, but the main goal is for nursing programs around the nation to benefit from the vital content it provides.

“In terms of nurses’ use of alcohol and substances, my goal is prevention and to get nurses ready to know what they might face in those first very vulnerable years,” Foli said. “We’re really wanting the nurses to be aware of how prevalent this disease is in all clinical settings for all individuals, including peers.”