Keywords

alcohol misuse, nursing education, student nurses, substance abuse

 

Authors

  1. Nair, Julie McCulloh PhD, RN, CCRE
  2. Nemeth, Lynne S. PhD, RN, FAAN
  3. Williams, Pamela Holtzclaw PhD, RN
  4. Newman, Susan D. PhD, RN
  5. Sommers, Marilyn S. PhD, RN, FAAN

Abstract

Background: The self-reported prevalence of alcohol use among U.S. college students decreased from 90.5% in 1980 to 79.2% in 2012. National efforts exist to reduce alcohol misuse among college students in the United States, yet little research addresses substance abuse among nursing students and even less addresses alcohol misuse. Alcohol misuse in nursing students may result in patient harm.

 

Purpose: This scoping study describes the state of the science of alcohol misuse among nursing students, guided by the research question: "What is the current state of alcohol misuse among U.S. nursing students?"

 

Methods: Evidence was drawn from several scholarly sources. Articles were included if they addressed U.S. nursing students; alcohol misuse; substance abuse or chemical impairment; prevalence rates; and/or characteristics including nursing student behaviors, attitudes, and beliefs. Using thematic analysis, common themes were extracted, followed by hand coding those themes and using NVivo qualitative software.

 

Results: Six studies met inclusion criteria. Three themes, eight subthemes, and several gaps in knowledge were identified. The themes include "high prevalence exists," "necessity of supportive environments," and "hopelessness without policies." Subthemes include "root cause," "vulnerable population," "scholarship and substance use," "education," "identification of risk factors," "prevention and deterrents," "safety," "ethical and legal issues," and "consequences."

 

Conclusions: On the basis of this analysis, several research questions were developed to explore alcohol misuse in this population. Alcohol was the most often used substance. Nursing students were unaware of a safe level of consumption and the potential negative health-related and professional effects associated with alcohol misuse.

 

Article Content

INTRODUCTION

Self-reported prevalence of alcohol use among U.S. college students decreased by 11% from 1980 to 2012 (Johnston, O'Malley, Bachman, & Schulenberg, 2013). Yet, 85% of students state they use alcohol, and 20% self-reported high-frequency alcohol use (three or more times a week; Core Institute, 2012). Consequences of alcohol consumption include alcohol-related health issues, academic decline, unintentional injuries, sexual assault, and death (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2013). Despite preventive efforts instituted by the NIAAA's Task Force on College Drinking, alcohol misuse and associated risky behaviors, including binge drinking, are continuously reported by college students at universities nationwide (NIAAA, 2007, 2012, 2013). Society's acceptance of alcohol misuse among college students, including nursing students, only perpetuates the situation (Fleming, 2002; Hyman, 2004).

 

Substance Abuse in Nursing Students

Four studies have determined prevalence rates of substance abuse among nursing students, one in 1981 by Haack and Harford (1984) and three longitudinal studies in 1982-1984 by Haack (1988), 1988-1992 by Marion, Fuller, Johnson, Michels, and Diniz (1996), and 1988-1991 by Coleman et al. (1997). Unfortunately, many methodological limitations were reported with those studies regarding sample selection, lack of generalizability, and problems with the choice of measures of prevalence (Smardon, 1998; Sullivan & Handley, 1992). Lack of research on this topic has led to a near-nonexistent knowledge base in this population (Sullivan & Handley, 1992). Stigma and vulnerability because of the potential for disciplinary action have made it difficult to explore nursing student addictions (Smardon, 1998; Sullivan & Handley, 1992).

 

The existing knowledge about substance use patterns in U.S. nursing students is founded on studies conducted primarily in the 1980s and 1990s, primarily during the NIAAA nursing faculty fellowship programs, raising concerns over the current relevance of existing data (Stevenson & Sommers, 2005). Sullivan and Handley (1992) asserted that younger nurses may be at greater risk for substance abuse because of the stress and demands of the job, and Smardon (1998) argued that nurses working within specialized areas may be at greater risk. Haack and Harford (1984) reported that nursing students in their study were not only weekly drinkers but consumed more alcohol than other female college students, and their rate of burnout was comparable with that of working nurses (Haack, 1988). These findings highlight the stress and demand of nursing education and the early career phase of nurses. This is of particular concern because nurses with substance abuse disorders have reported that this behavior begins before or during nursing school (Coleman et al., 1997). Thus, further research is warranted to determine (a) current drinking patterns of nursing students and young nurses, (b) the factors that contribute to substance abuse in nursing education and practice, and (c) current prevalence rates.

 

Where are We Now?

Limited research has been conducted over the last 20-30 years, despite rates of alcohol misuse among college students increasing over the last decade. Prevalence rates and behaviors of nursing students (future nurses) are unknown. Research citations are from quantitative studies (no qualitative studies identified) and more than 10 years old, creating uncertainty over current nursing students' substance use behaviors. Lack of current knowledge is related to protection of college students through privacy laws preventing data collection associated with substance abuse, overprotection of the nursing image, lack of interest among nurses to research nursing students, lack of research funding, and lack of faculty documentation of student substance abuse occurrences at their respective institutions (Polk, Glendon, & DeVore, 1993). The lack of research on the adherence to, and variation among, nursing student policies on substance abuse signals the need for an exploration of the originating causes and characteristics of chemically impaired nursing students (Haack, 1985; Monroe & Pearson, 2009; Smardon, 1998; Sullivan & Handley, 1992).

 

Research Aims

The purpose of this review is to (a) report current prevalence data about alcohol misuse by nursing students by identifying themes and gaps found within the literature and (b) provide a roadmap for future mixed methods research designed to explore alcohol use, misuse, and abuse within this potentially vulnerable population, as a basis to influence future academic policies. The following research question was used to guide this study: What is the current state of alcohol misuse among traditional college-age nursing students in all programs?

 

METHODS

Study Design

A descriptive scoping study of existing literature pertaining to nursing students and alcohol misuse was used, following Arksey and O'Malley's (2005) methodological framework (see Appendix A). Scoping studies aim to provide a comprehensive overview but not an in-depth analysis of a subject. Preliminary evidence is drawn from several sources that include research and nonresearch (white papers, editorials, gray literature), a strategy employed in this design to identify a variety of knowledge regarding alcohol misuse among nursing students. As a result, quality appraisal is not necessary as in systematic reviews, which seek to appraise and synthesize existing empirical evidence meeting prespecified inclusion criteria (The Cochrane Library, 2014). Scoping reviews also allow for analytical reinterpretation of the literature, whereas integrative reviews seek to identify and organize existing data (Davis, Drey, & Gould, 2009; Levac, Colquhoun, & O'Brien, 2010).

 

Scoping studies are also appropriate for the synthesis of a broad base of existing evidence, providing an overview of a specific issue or topic (Davis et al., 2009). The method is particularly appropriate for this study, as many literature sources were reviewed and used to inform either the background or results sections of this article and provide support for the development of a roadmap in future research. The flexibility of this multiphase design enables exploration of existing data through various forms of literature, reading and rereading the original studies to gain familiarity with the content to further refine, clarify, and define the existing data and identifying conceptual limitations associated with the topic under investigation (Davis et al., 2009).

 

Definition of Terms

Several terms, often used interchangeably, are found related to impairment of nursing students. Yet, particular nuances distinguish these terms. The first two terms below function as umbrella terms regarding the range of specific disorders, whereas the third refers to a condition. In this study, the terms will be operationally defined as follows:

 

1. Substance use disorder is defined in this study by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition(American Psychiatric Association, 2013) as a disorder measured on a continuum from mild to severe that is addressed by a specific substance such as alcohol or stimulants. It is often referred to as substance misuse and abuse.

 

2. Alcohol misuse describes a range of behaviors and consists of three main patterns of alcohol consumption that include hazardous drinking, harmful drinking, and dependent drinking. Hazardous drinking occurs when people drink beyond the recommended weekly limits, which is 14 drinks for men and seven drinks for women. Binge drinking occurs when people drink beyond the daily limits (four drinks for men and three drinks for women) over a short period (NIAAA, 2010). Harmful drinking is defined as individuals drinking over the recommended limits and experiencing health problems related to alcohol use (NIAAA, 2010), whereas dependent drinking (alcoholism) is defined as being physically and psychologically addicted to alcohol (National Health Service, 2011).

 

3. Chemical impairment refers to nurses who are unable to function competently in their role because they are impaired by a chemical substance, such as alcohol or drugs. Psychological dependence occurs when a person believes he or she needs a substance to cope with his or her emotions, whereas physical dependence occurs once a person builds tolerance to and then stops using a chemical substance at which time his or her body begins the withdrawal process (Doweiko, 2011). Dependence should not be confused with nurses who have a substance use disorder because they may be fully functioning and not considered impaired and capable of delivering safe care in the clinical setting (Haack & Yocom, 2002; National Council of State Boards of Nursing [NCSBN], 2011).

 

 

Search of the Literature

A comprehensive search of scholarly databases included the Cumulative Index of Nursing and Allied Health Literature, PubMed, and PsychINFO. Mesh terms identified in PubMed included ("students, nursing"[mesh]) or "schools, nursing"[mesh] and ("alcohol-related disorders" [mesh]); and ("students, nursing" [mesh]) or "schools, nursing" [mesh]) and "substance-related disorders" [mesh]) not ("students, nursing" [mesh]) or "schools, nursing" [mesh] and ("alcohol-related disorders" [mesh]). Keywords used to search Cumulative Index of Nursing and Allied Health Literature, and PsychINFO included "nursing students, alcohol" and "nursing students, substance abuse." Additional sources were located through hand searches of reference lists and use of two Web-based search engines, Google Scholar and Rutgers University's Alcohol Database, using the same keywords to identify additional peer-reviewed publications and gray literature to further identify relevant articles. A second search of the literature was conducted by reviewing the results of the initial search and focusing only on current articles based on the exclusion criteria as described in the following paragraph.

 

Articles were included if they addressed all nursing students (Associate of Science in Nursing, Bachelor of Science in Nursing (BSN), and diploma; commuters and residents) in the United States, and alcohol misuse, substance abuse, or chemical impairment as well as prevalence rates and/or characteristics including nursing student behaviors, attitudes, and beliefs associated with this topic were reported. Articles were excluded if they were not written in English, focused primarily on policy and curriculum development, and were published before 1998. Articles more than 15 years old were not reflective of current trends in all nursing programs; thus, the year 1998 was chosen as the cutoff for inclusion criteria. In addition, articles written about nursing students in other countries were excluded because of concerns over cultural and educational differences of global regions.

 

Data Selection: Review of Literature

Two hundred seven articles were identified from search engine methods, and one was identified through a hand search of references. Articles were initially screened by reviewing abstracts to determine the purpose, but many were reviewed in entirety because of the absence of abstracts and to determine further relevance in a second screening resulting in 29 articles. After the second screening, an additional 23 articles were excluded because they did not meet inclusion criteria (see above). The six final articles were selected based on inclusion and exclusion criteria and their relevance to the topic at hand (see Figure 1).

 

DATA ANALYSIS

Articles selected for final review were read in entirety, and data were extracted and categorized based on study characteristics: purpose, sample, setting, design, methods, theory/framework, outcomes, comments, future research recommendations, potential themes, and gaps. An extraction tool (matrix table) was developed to assist with thematic analysis, determination of common features (themes) that are relevant to the study topic (Charmaz, 2006; Sandelowski & Barroso, 2006; Tuckett, 2005; see Table 1). Content was organized and grouped into common themes that were then abstracted to provide refined themes that are inclusive of each other (Sandelowski & Barroso, 2006).

  
Table 1 - Click to enlarge in new windowTABLE 1 Study Characteristics of NSs and Alcohol Misuse Found in the Literature Between 1998 and 2013

Articles were imported into NVivo 10.0 software (QSR, International Pty, Doncaster, Australia) for qualitative analysis. Data were initially hand coded by identifying words and short phrases from the texts that were symbolic or meaningful and considered potential themes. Memos were used throughout the data analysis phase to document key thoughts or ideas that would assist with the creation of potential themes, or linking themes together, and to assist with the summary of findings. Analytical themes were eventually created from the refined initial themes to assist with the data analysis process.

 

RESULTS

Review of Current Literature

Six articles were selected for review based on data selection criteria that discussed nursing students and substance abuse, alcohol misuse, and/or chemical impairment. Three overarching qualitative themes were identified upon completion of thematic analysis. Within each of those themes, several subthemes emerged along with several gaps in knowledge. Together, these themes provide a theory as to what is currently known regarding nursing students and substance abuse, alcohol misuse, and chemical impairment, whereas the gaps identify what currently remains unclear or unknown. The three themes, and their respective subthemes, are presented in Table 2. A summary of findings follows.

  
Table 2 - Click to enlarge in new windowTABLE 2

Summary of Findings

Alcohol use is highly prevalent among nursing students.

This most common theme among all sources was that a high prevalence of drinking exists in nursing students. Two studies reported current rates of alcohol and drug use in their specific samples, but only one of those studies (Gnadt, 2006) occurred in the last decade. Baldwin et al. (2009) published their results of a study conducted in 1999, which may not reflect current trends. Both studies provided the most up-to-date rates of use and reported high prevalence rates of both alcohol and drug use among nursing students.

 

Baldwin et al. (2009) reported 84.3% prevalence of alcohol use in the past year in a sample (n = 471) of BSN students. Of those students, 15.7% self-reported past-year abstinence from alcohol, 18.3% drank five or more drinks per typical occasion, 32% drank five or more drinks over the past 2 weeks, and 11 students reported abstaining from alcohol use because of recovery from alcohol dependency. Gnadt (2006) reported current use of all substances to be 24% among Associate of Science in Nursing and BSN students who attend a religious-based college or university and further cited alcohol use at 82% and as the most frequently used substance among those surveyed. These findings are strikingly similar to the findings reported by Baldwin et al. despite the differences in sample demographics found in both studies. In contrast, a sample of schools was surveyed to determine incidence of substance abuse on their campuses, and 83% of respondents reported having issues in the past and at times referring students for treatment (Polk et al., 1993).

 

Underlying the high prevalence of alcohol use by nursing students, subthemes included root causes, nursing students as a vulnerable population, and scholarship and substance use. The discussions about prevalence included "root causes" to seek to understand the cause of substance use among students. Root causes cited included family history of substance use, stress and rigors of work and nursing school, financial burden, peer influence and new independence, lack of university support, and medical conditions, which all contributed to an increased risk (Baldwin et al., 2009; Gnadt, 2006; Spier et al., 2000).

 

Nurses have reported substance abuse begins during nursing education because of the associated stressors, which indicates the "vulnerability" of this population. However, because research is lacking, nursing students and practicing nurses are not considered at higher risk than the general population (Buckner, 2002). In addition, scholarship and substance abuse were noted as potential risk factors because students who were highly ranked in their class were also found to have high rates of substance abuse (Buckner, 2002; Pierce, 2001).

 

Necessity of supportive environments.

A supportive environment is essential for nursing students and requires several elements that include counseling and health services, closer faculty and student relationships, addiction education, and policies and guidelines to assist with chemically impaired students (Baldwin et al., 2009; Buckner, 2002; Pierce, 2001; Polk et al., 1993). Substance abuse prevention is vital on campus. This may include reduction of available sources of addictive substances such as alcohol vendors and placing limitations on the amount of alcohol licenses approved for a certain radius around campuses (Baldwin et al., 2009). Peer assistance is also needed to provide support among nursing peers, or the prevalence of substance abuse will continue because of acts of commission and omission, which include not recognizing alcohol as an addictive substance and covering for impaired peers (Pierce, 2001).

 

Faculty face similar challenges when addressing suspected substance abuse and would benefit from policies that provide a strategy to address chemically impaired students in a constructive manner (Spier et al., 2000). Similarly, clear and consistent guidelines are needed regarding rehabilitation of nursing students at both the institutional and state levels (Polk et al., 1993). Currently, rehabilitation policies for nursing students are often left to the institution in which they are enrolled (Pierce, 2001), and the state board of nursing may not have jurisdiction over those nursing students, leaving the state board unable to assist with this issue (Polk et al., 1993). However, states can create guidelines for nursing education programs to implement regarding rehabilitation of nursing students that should include advice on self-report, peer report, or faculty report of probable substance abuse (Pierce, 2001).

 

Education was cited often in all sources but mentioned primarily when referring to nursing education curricula. Students were not only unable to identify acceptable levels of consumption but also unable to identify addictive substances, and some stated alcohol was not an addictive substance (Baldwin et al., 2009; Pierce, 2001). Both students and nursing faculty were unable to recognize the signs and symptoms of a chemically impaired student or peer and were not sure how to confront the chemically impaired or dependent individual (Pierce, 2001; Polk et al., 1993). Thus, Baldwin et al. (2009) stated that further education on addiction is needed and suggested mirroring the current model of treatment for substance abuse and addictions.

 

Moreover, identification of risk factors and deterrents was addressed along with education. Several references to patterns of behavior and factors that either increased or decreased substance abuse among nursing students were noted. Early identification of risk factors may assist with reduction of substance abuse in nursing students and in nursing overall. Nurses have reported that their addictions began during nursing school, and disciplinary actions related to substance abuse are frequently reported by the state boards of nursing (Gnadt, 2006; Pierce, 2001). Furthermore, students who reported higher consumption rates were found to have more risk factors for substance abuse and dependence than those who drank at lower levels (Gnadt, 2006). Those who participated in Greek affiliations and athletics reported an increased risk for binge drinking (Baldwin et al., 2009; Pierce, 2001). Conversely, those who frequently participated in religious services had a decreased risk for substance use (Gnadt, 2006). Thus, to decrease incidence of substance abuse, further investigation of risk and protective factors associated with nursing addictions is needed (Baldwin et al., 2009; Buckner, 2002).

 

Hopelessness without policies.

Challenges exist for many students and faculty when policies are not in place for addressing chemically impaired students. Faculty find these situations to be emotional and express distress at being unable to assist students in need (Polk et al., 1993). Without policies, faculty members are unable to determine treatment and rehabilitation options or how to best remove chemically impaired students from the clinical setting (Gnadt, 2006; Polk et al., 1993; Spier et al., 2000). Protective policies ensure patient and public safety (Buckner, 2002). At present, it is unknown how many students are practicing impaired, and there is no system to track these individuals (Gnadt, 2006).

 

Several legal and ethical issues exist regarding chemically impaired students, including upholding a student's privacy, remediation, rehabilitation, and return to school and practice. If students are impaired while at school or in the clinical setting, unintentional harm to either the student or patients may result. Responsibility for safe practice falls on the university, school of nursing, and clinical faculty (Spier et al., 2000). However, without policies or use of required blood and urine testing, it may be difficult to maintain safe standards and remove students from the clinical practice (Polk et al., 1993; Spier et al., 2000). Polk et al. (1993) reported that 49% of faculty do not confront students suspected of chemical impairment, nor do department chairs or deans report these same students to their state board of nursing even if the reporting mechanism is mandatory in their state, and there is no system in which to follow these students to ensure they remain safe to practice.

 

Identified gaps.

Several gaps were identified by each source. Much remains unknown regarding current prevalence rates, behavioral trends, root cause, and lack of policies regarding substance abuse and nursing students (Baldwin et al., 2009; Buckner, 2002; Gnadt, 2006; Spier et al., 2000). A paucity of nursing literature regarding this topic remains (Gnadt, 2006). Lack of guidelines or policies was cited for protection of students and the public. There is either no method for peer confrontation or no model for use in chemically impaired students (Pierce, 2001). Baldwin et al. (2009) addressed the lack of knowledge regarding the root cause of substance abuse, whereas Gnadt (2006) addressed the lack of a national reporting system to track student nurses. In addition, a lack of prevention, addiction, and substance abuse education was reported by Pierce (2001). Thus, the need for current literature remains to better understand substance abuse among nursing students (Baldwin et al., 2009; Buckner, 2002; Gnadt, 2006; Spier et al., 2000).

 

Limitations

Several figures and tables are provided detailing the method process of this study to ensure descriptive validity and transparency of findings. Interpretive validity may be a limitation in this study because of one investigator conducting this thematic analysis. Coding of all themes was completed by hand in matrices, and then, all articles were uploaded in NVivo for further analysis that included the auto coding and auto reports to ensure an accurate identification of themes and gaps (Sandelowski & Barroso, 2006). Reflexive memos were written to identify and reduce bias of the researcher.

 

DISCUSSION

Identifying actual prevalence rates in nursing students remains difficult because of a lack of current research on this topic, but based on the two studies identified in this scoping review that reported rates of alcohol use, they are similar to the national alcohol use rates of all college students. The rate of alcohol and other drug use has remained high and persistent over the past 3 decades, but how this is impacting the profession is unknown (Core Institute, 2012). The last known prevalence and causality study was conducted in 2006 and not likely representative of current trends. The data are also not generalizable to the entire nursing student population because the sample was representative of nursing students attending Seventh-day Adventist colleges in the United States, in which specific social and religious norms do not support the use of alcohol.

 

Risk and protective factors were identified, reflecting that students at the top of their class were once again identified as those drinking at unsafe levels, which was also mentioned in the early 1900s and again in the 1990s (Buckner, 2002; Coleman et al., 1997; Heise, 2002; Pierce, 2001). Therefore, more research is needed to identify specific risk and protective factors that contribute to the vulnerability of this population.

 

A supportive environment with prevention and rehabilitation efforts is needed. Lack of close faculty and student relationships was found as an issue; however, faculty must also maintain objectivity and a professional standard of conduct. Therefore, the forging of close relationships may be helpful but also raises questions about how to maintain professional boundaries as described by the Code of Ethics for Nursing (American Nurses Association, 2001). This type of relationship would also demand the provision of additional time to assist impaired students, which may not be feasible for all nursing faculty. Perhaps, the formation of a task force, along with peer assistance groups located within each nursing school, may be a better option as long as faculty and student peers are allotted sufficient time and resources to assist impaired students. Otherwise, universities need to consider the additional stressors placed on student nurses and ensure they are receiving adequate assistance through campus health and counseling services, in addition to campus peer assistance programs.

 

Nursing curricula along with faculty development also need further examination. Students are unaware of the associated dangers of substance abuse, which was well documented by Baldwin et al. (2009) and Pierce (2001). Faculties were unaware of signs and symptoms of chemically impaired students and lack approaches for intervening with these students. Knowledge deficit leads to frustration among faculty, confusion among students, and worst of all, continued substance abuse that more than likely continues into the student's early nursing career. Role playing to assist students build skills regarding confrontation of peers might help students as well as faculty to better address chemically impaired students. This appears to be a missed opportunity to not only prevent substance abuse but also educate and rehabilitate students, which may lead to decreased rates of nursing addiction in the future.

 

Lack of policy is another issue contributing to alcohol misuse and abuse, as found in nearly every aspect of identified themes. Because of the lack of regulatory policies, prevalence rates are unknown and unmonitored. Lack of school policy on how to treat the chemically impaired student only perpetuates the situation by allowing the substance abuse to continue, because faculty are uncertain as to how to address, manage, rehabilitate, and monitor chemically impaired students. Without uniform guidelines, substance abuse will continue to be an issue in the future.

 

On the basis of findings from the review of literature, a theoretical model or framework does not exist for use within this population. Alternative to discipline approaches exists for treating addicted nurses (NCSBN, 2011) that could be adapted for use in nursing students. Evidence-based models should be considered for use in establishing a theoretical model for nursing students. Protective polices and a monitoring system warrant careful consideration so that patient safety is maintained and nursing students receive adequate assistance and supervision when facing an addiction. Thus, a tracking system at the state or national level may help to reduce the incidence of impaired nursing students from practicing in an institution where patients could be harmed.

 

A system similar to Nursys, which was developed by the NCSBN to monitor and share disciplinary actions of nurses in each state, could be used in the nursing student population for those students unwilling to seek treatment. This type of system could be developed and implemented if nursing programs and their respective state boards of nursing agree to work together on this initiative. Although barriers currently exist that relate to privacy policies and lack of nursing program oversight by many state boards of nursing, a few do provide oversight and work closely with their nursing programs, requiring the directors and deans of these programs to report nursing students with substance use disorders and assist students with the rehabilitation process.

 

Presently, nursing students are able to leave one school and enroll in another school without having to report prior substance abuse issues, much like registered nurses did before the establishment of Nursys (NCSBN, 2011). Nurses were able to move from state to state, reestablishing their practice even if they received a disciplinary action, because those occurrences were not tracked at a national level with state cooperation (NCSBN, 2011). Therefore, future investigation of a similar program for nursing students is recommended along with a recommendation for further development and implementation of alternative to discipline programs for nursing students. Consideration about their developmental stage and associated issues that were discussed earlier should be considered while drafting programs, and nursing students should have resources available to them to treat their addictions. Finally, the reported gaps were many and were already addressed throughout this discussion, but it is imperative to stress once again that a lack of scientific evidence still exists related to alcohol misuse and nursing students despite the acknowledgment of this issue over the past 30 years.

 

CONCLUSION

The purpose of this study was to scope the current situation regarding nursing students and alcohol misuse by reviewing the literature. The intent was to provide evidence that may be used to inform future research that is designed to explore alcohol use, misuse, and abuse within this population. Alcohol remained the most prevalent substance of use among nursing students. Students were, for the most part, unaware of alcohol's addictive nature or what is considered a safe level of consumption. They remain unaware of the risk for addiction because of the lack of education on this subject. They are particularly vulnerable and at higher risk for alcohol misuse because of the additional adult responsibilities they assume as nursing students because they may not have adequate coping mechanisms in place to manage the stressful situation that often occurs in clinical nursing. Therefore, this scoping review provides convincing evidence for specific research based on the themes found in this review. These themes can be used to guide further studies of nursing students related to substance use and guide policy revisions and implementation of new assistive programs in the future.

 

Acknowledgment

The corresponding author would like to thank her dissertation committee for their gracious contribution of time, expert guidance, and editing during the research and writing of this article, which is part of the author's doctoral coursework at MUSC.

 

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