Association between nurses' knowledge and attitudes and caring behaviors toward people with opioid use disorder

Hospital nurses are crucial in inpatient OUD care, but knowledge gaps and negative attitudes may affect care quality. Few studies have examined the relationship between nurses' knowledge and attitudes and their caring behaviors toward patients with OUD in hospital settings.

We conducted a descriptive, exploratory cross-sectional study among hospital nurses at two northeast U.S hospitals. To explore nurses' perspectives, we used validated instruments to assess knowledge and attitudes [DDPPQ] and caring behaviors [CBI-6]. DDPPQ and CBI-6 scores were treated as ordinal composite measures and summarized using medians and interquartile ranges. Group differences were examined across demographic and work-related factors using Mann-Whitney U and Kruskal-Wallis tests. Associations between DDPPQ and CBI-6 scores were analyzed using Spearman's rank correlation with bootstrapped confidence intervals. Median (quantile) regression (τ = 0.50) was used to assess adjusted associations.

A total of 125 nurses completed the survey. Most nurses were female (94%), white (82%), and employed full-time (87%). Higher DDPPQ scores, indicating lower knowledge and more negative attitudes, differed by years of experience and hospital site. CBI-6 scores varied by shift type, with permanent night-shift nurses reporting the highest median caring behaviors. Higher DDPPQ scores were significantly associated with lower caring behaviors (ρ = -0.42; 95% CI: -0.52 to -0.30; p < 0.0001). Even after adjusting for shift type, years of experience, and hospital site, higher DDPPQ score remained significantly associated with lower CBI-6 score (β = -0.11; 95% CI: -0.16 to -0.06).

Hospital nurses with lower knowledge and more negative attitudes reported lower caring behaviors toward patients with OUD. These findings identify knowledge and attitudes as potential modifiable factors in inpatient OUD care and support future research to clarify causal pathways and explore the potential of educational and empathy-based strategies to improve OUD care.