Chapter Eleven – Section 1: Opioid Use Disorder
Practical Application: Book Activity
Practical Application
Setting the Scene
The Opioid Epidemic is widespread, affecting every state in the United States. KFF, an independent polling and public policy research company, has a collection of data related to the epidemic, including information on deaths and the prevalence of opioid use disorder. The collection can be accessed at https://www.kff.org/statedata/collection/opioid-epidemic/
Think About It
Using the KFF collection, look up the data for your state.
- Does the death rate from opioid overdose in your state surprise you? Why or why not?
- Which of the classifications of data (e.g., death by sex or age) was the most surprising?
- Did your state differ from national trends in any categories? What aspects of the community might influence this difference?
- What do you think is one thing that might lessen the opioid-related death rate in your state?
Practical Application: Additional Guidance
Exercise Title
Targeted Community Health Strategies to Address the Opioid Epidemic
Objectives
- Identify the opioid death rate in your community based on age and racial and ethnic groups
- Discuss culturally competent interventions to target populations at risk
Preparing for the Exercise
- Review the Chapter Material:
- Read Chapter Eleven: Opioid Use Disorder.
- Understand key concepts related to the opioid epidemic
- Gather Resources:
- Collect relevant materials, including textbooks, articles, and online resources.
- Explore real-world examples (videos, case studies) to ground students’ understanding of real world impact the opioid use.
Exercise Components
- Gathering the data (30 minutes)
- Identify a community based on geographical location.
- Gather data regarding opioid death from available local, state and federal resources.
- Organize students into small groups
- Each group is assigned one group within the data, such as age, race, gender etc.
- Identifying the strategies. (30 minutes)
- Groups identify evidence-based strategies that target their assigned group
- Presenting the strategies. (30 minutes)
Each group presents their strategies- Each group presents their strategies
Evaluation and Assessment
- Group Presentation: Assess student’s ability to identify culturally competent interventions to address the opioid epidemic within a targeted population.
- Individual Reflection: Ask students to write a brief reflection on the exercise, highlighting key takeaways and areas for improvement.
Integration into Curriculum
- Alignment with Course Objectives: Integrate evidence-based strategies to address opioid use disorder into nursing courses.
- Sequencing: Determine the appropriate timing and sequencing of the exercise within the course curriculum to complement other content and activities.
- Integration of Theory and Practice: Include case studies that utilized evidence-based strategies to address opioid use disorder.
Resources and Support
- Learning Resources: Provide students with access to relevant literature, articles, and resources on opioid use disorder, including:
- Faculty Support: Offer guidance, feedback, and support to students as they engage in the exercise, addressing any questions or concerns they may have about the scenario or related topics.
Conclusion
By identifying data within a designated community along with targeted strategies regarding the Opioid Epidemic, it becomes clear as to the role nurses play in addressing the crisis along with evidence-based targeted strategies.
Additional Activities
Role-playing/Communication Exercise
Scenario Title
Opioid Use Disorder
Objective
To engage learners in applying an identified targeted strategy to address some aspect of the opioid epidemic such as Naloxone availability for immediate use in overdose hotspot areas.
Roles
- Community Health Nurse (Played by 2 students)
- Librarian at City Library
Scenario Setup
You are a community health nurse and your local library and the area near it has seen an increased number of incidents related to opioid overdose. Based on this information and through the support of your local government, you arranged a teaching session for all of the librarians to receive education and training regarding Naloxone and its use.
Background resources
- Guidelines for the use of Naloxone
- Naloxone Training Kit- Naloxone Toolkit | Overdose Prevention | CDC
Community Education Activity
- Pre-Exercise Briefing
- Brief participants on educational strategies
- Verbal
- Written
- Review Naloxone
- What is it
- Why is it important
- How is it used
- Discuss Strategies to Evaluate Learning:
- Read back
- Return Demonstration
- Brief participants on educational strategies
- Scenario Introduction
- Introduce the scenario to participants and assign roles. Provide background information about the increased incidence of opioid overdoses within the community, especially in and around the library. The local health department worked with community leaders to offer an educational session for the public health nurses to educate the librarians on Naloxone.
- Scenario Description:
- The librarian and nurses meet in the library.
- The nurse’s role is to provide education to the librarian regarding Naloxone.
- Role-Play Interaction
- Participants engage in a role-play interaction where the nurse applies educational strategies
- Role-Play Guidelines:
- Nurse focuses on recognizing librarians’ willingness to learn.
- Nurse demonstrates best practices in educating learners
- Nurse uses teach back method to evaluate learners level of understanding
Debriefing and Feedback
After the role-play, conduct a debriefing session where each participant reflects on their experience, provides feedback, and discusses lessons learned.
Debriefing Questions
- How did you approach the learner to assess willingness to learn?
- What teaching strategies did you use?
- Were there any challenges in engaging your learner?
Feedback:
- Participants provide feedback to each other based on observed educational strategies
- Facilitator offers guidance and additional insights on educational strategies.
Reflective Practice
This activity could occur on a discussion board or by uploading a video using Flip or Canvas Studio.
- The ANA issued a brief in 2018 “The Opioid Epidemic: The Evolving Role of Nursing” . In consideration of your education and associated experiences, discuss how you envision your role as a nurse or future nurse in addressing the opioid epidemic.
- How do you feel when you think about caring for clients with opioid use disorder? Do you notice any assumptions, fears, or biases that come up for you? Where do you think these feelings stem from (e.g., personal experiences, media portrayals, societal attitudes)?
Simulation
Scenario Title
Therapeutic Communication with a Client with Opioid Use Disorder
Objective
- To enhance the nurse’s ability to communicate therapeutically with clients who have an opioid use disorder.
- To practice motivational interviewing skills and therapeutic boundaries.
- To address stigma and demonstrate nonjudgmental support.
Roles
- Nurse (Participant A)
- Client (Participant B)
- Observer
Scenario Setup
The client has been admitted to the hospital after an overdose related to opioid use. The client expresses ambivalence about quitting and feels ashamed and defensive. The nurse’s goal is to support the client’s health needs, understand the client’s perspective, and help the client explore readiness for change.
Role-Play Activity
- Setting the Scene
- Nurse: Start by establishing a calm, nonjudgmental environment. Acknowledge the client’s experience and allow them to share their thoughts.
- Client: You’re feeling conflicted about your opioid use. You have some desire to quit but also fear the withdrawal process and don’t trust that anyone can help you. You may feel defensive, scared, and overwhelmed.
- Role-Play the Interaction
- Nurse’s Goals
- Use open-ended questions: Start the conversation by exploring the client’s thoughts without forcing solutions.
- E.g. “Can you tell me a bit about what you’re feeling right now?”
- Express empathy: Acknowledge the difficulty the client is going through and validate their emotions.
- E.g. “It sounds like you’re carrying a lot right now. That must feel overwhelming.”
- Avoid judgment: Ensure that your tone and body language are nonjudgmental and accepting.
- Motivational Interviewing: Gently guide the client to explore their own motivation for change.
- E.g. “What are some of the things you’d like to change about your current situation?”
- Support autonomy: Make it clear that the client is in control of their own choices.
- E.g. “It’s really up to you what you decide to do. What do you think your next step should be?”
- Use open-ended questions: Start the conversation by exploring the client’s thoughts without forcing solutions.
- Nurse’s Goals
- Express your ambivalence: You want to convey that you feel conflicted about your opioid use and the idea of quitting.
- Show some defensiveness: At times, push back or deflect to demonstrate how clients might respond when feeling overwhelmed or judged.
- E.g. “I don’t see how anything’s going to change. No one’s ever really helped me.”
- Reveal underlying fears: At some point, express fear or reluctance related to withdrawal or change.
- E.g. “I’m scared of what it’s going to be like if I stop. I’ve tried before, and it was awful.”
- Nurse’s Goals
- Observer Feedback (If applicable)
- How well did the nurse listen without judgment?
- Did the nurse use open-ended questions and empathetic statements?
- Did the client feel heard and respected in the conversation?
- Were motivational interviewing techniques used effectively?
Debriefing and Feedback
After the role-play, conduct a debriefing session where each participant reflects on their experience, provides feedback, and discusses lessons learned.
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- For the Nurse: How did you feel during the interaction? Was it difficult to avoid giving advice or passing judgment?
- For the Client: Did you feel supported and understood during the conversation? What made you feel defensive or open?
- For the Observer: What did you notice about the nurse’s communication? Were there any missed opportunities for deeper connection or support?v