From Discomfort to Connection: A Qualitative Analysis of Nursing Students' Debriefing on Opioid Use Disorder Focused Simulations

Introduction 

Substance use disorder (SUD) affects over 296 million individuals worldwide, representing 5.8% of the global population aged 15-64 in 2021. SUD, particularly opioid use disorder (OUD), presents a significant healthcare challenge, often compounded by negative attitudes and stigma among healthcare providers including nurses and nursing students. Education and clinical exposure, including simulations, are linked to reducing stigma.

Goals and Methods

This qualitative descriptive study aimed to examine the effectiveness of OUD-focused simulations co-created with input from the OUD community and guided by the AMERSA competencies. Six high-fidelity NO STIGMA OUD simulations were developed for use throughout a nursing curriculum to reduce stigma and enhance empathy when caring for individuals with OUD. Each simulation was pilot tested with 10 students with 60 students completing the program.  Following completion of the simulation, the students were debriefed by a member of the research team using a standardized debriefing outline.

Results

Thematic analysis of student responses revealed significant shifts in their understanding  and approach to patient care following the simulations and debriefings. Initially, student reflections were categorized under two themes: "Limited Knowledge of OUD" and "Out of My Comfort Zone," highlighting a lack of familiarity and comfort with OUD. However, the debriefing process fostered a deeper understanding of the complexities of caring for individuals with OUD, as evidenced by the emergence of four new themes: "Recognizing Stigma," "Treating the Person – Not the Disorder," "The Importance of Caring Behavior," and "Building Connections."

Conclusions

This study demonstrates the transformative potential of community-informed simulations in nursing education. By bridging knowledge gaps, challenging preconceptions, and fostering empathy, the NO STIGMA simulations encouraged students to adopt a person-centered approach to OUD care. The findings highlight the importance of incorporating lived experiences into simulation design and underscores the need for further research into the long-term impact of such interventions.