The Patient With the Abscess Who Left Before Morning: Opioid Use Disorder in a Four-County Region and the Substance Use Thread a Rural BSN Curriculum Is Missing
Student Name
American College of Education
NUR6003: Influencing Forces in Nursing Education
Module 4 Assignment
Instructor Name
February 4, 2030
The Need in the Region
Our program draws most of its students from, and sends most of its graduates to, a four-county region with a combined population of about 180,000. The region's most recent community health needs assessment, prepared jointly by the regional health system and the four county health departments, ranked drug overdose first among its health priorities, ahead of heart disease and diabetes, on the basis of overdose death rates well above the state average and the views of residents and community organizations. The hub hospital's own data show the problem at the bedside. Each week it admits several patients with complications of injection drug use, most often skin and soft tissue infections, and less often endocarditis or osteomyelitis requiring weeks of intravenous antibiotics. Nurses on the medical units describe the pattern: withdrawal begins within a day, pain is poorly controlled, the patient becomes distressed and some leave before treatment is complete, often at night.
What the Need Asks of New Nurses
A new graduate on one of those units needs to be able to do several things our program does not currently teach as a set. They need to recognize and assess opioid withdrawal with a structured scale, manage pain in a patient with opioid tolerance, explain and support the start of medication treatment during the admission, teach patients and families to use naloxone, and plan a discharge that connects the patient to ongoing treatment. Above all, they need to approach the patient without the judgment that makes people leave.
The case for hospital-started treatment is strong. In a randomized trial among hospitalized patients with opioid dependence who were not seeking treatment, those who began buprenorphine in hospital and were linked to outpatient treatment after discharge were far more likely to enter treatment than those given a five-day detoxification, 72.2% compared with 11.9%, and reported less illicit opioid use six months later, although keeping patients in treatment remained difficult (Liebschutz et al., 2014). Nurses do not prescribe buprenorphine, but they assess readiness, manage withdrawal and pain around it, teach and coordinate the handoff to outpatient care, and their approach affects whether the patient stays long enough for it to begin. A patient who leaves at 0300 with half a course of antibiotics has been failed by a system, but the last person they spoke to was usually a nurse.
What Students Bring
Our students come from these counties, and many have seen the effects of substance use in their families and communities. That experience can cut both ways. In a survey of 193 prelicensure nursing students using a validated scale of provider attitudes toward opioid use, those with personal experience of substance use disorder had lower stigma scores than those without, and 71% wanted content from people with lived experience included in the curriculum (Crook et al., 2025). Education can change attitudes. In a program that added substance use content throughout its curriculum, students' scores rose after completing it on most subscales of two perception questionnaires, including role adequacy, role support and role legitimacy for working with patients who use alcohol or other drugs, although one measure of role-related self-esteem moved in the wrong direction (Finnell et al., 2022). The evidence suggests that a curriculum can build both the skills and the willingness to use them, and that it should use students' own experience and the voices of people in recovery rather than treating the topic only as pharmacology.
What the Curriculum Does Now
I audited every course syllabus and examination blueprint for content on substance use. The pharmacology course covers opioid pharmacology, naloxone and the medications used to treat opioid use disorder in one lecture. The mental health course spends a week on substance use disorders, focused on diagnosis and alcohol withdrawal. Adult health courses mention injection drug use as a risk factor for endocarditis. No course teaches a withdrawal assessment scale for opioids, pain management for patients with opioid tolerance, naloxone teaching or discharge planning for linkage to treatment, and no clinical course asks students to reflect on caring for a patient who uses drugs. The content that exists is accurate but scattered, and it stops at knowledge. It does not reach the Population Health domain of the Essentials, which asks graduates to engage communities and partners in addressing health needs (American Association of Colleges of Nursing [AACN], 2021), and it leaves the bedside skills to chance.
Partners and Constraints
A program cannot meet a community need alone, and three constraints shape what ours can do. The first is faculty expertise. None of our twelve full-time faculty holds a certification in addictions nursing, and only two have practiced on units where medication treatment was started in hospital. Before the thread begins, two faculty members will complete a continuing education program on substance use care, and the hub hospital's addiction consult nurse, who joined the health system last year, has agreed to co-teach the simulation. The second constraint is clinical access. Students cannot be assigned to patients in active withdrawal on every rotation, and some preceptors are uncomfortable with them doing so, which is why the thread relies on simulation for the bedside skills and on community events for naloxone teaching. The third is the community itself. The region's peer recovery organization is small, its staff are stretched and speakers in recovery must not be treated as unpaid teaching aids. The program will pay honoraria from the continuing education budget and will ask the organization what it wants from the partnership, which may include placements for community health students. Working within these constraints keeps the proposal realistic, and each partnership also strengthens the program's relationship with the community it serves.
A Thread Through Four Courses
Rather than a new course, I propose a thread across four existing ones. In Pharmacology, the lecture on opioids will add a case in which students compare detoxification with medication treatment using the trial evidence. In Mental Health, the substance use week will add opioid withdrawal assessment with a structured scale, a session with a speaker in recovery from the region's peer support program, and a short reflection on students' own assumptions. In Adult Health II, one simulation will present a patient with an abscess and opioid use disorder in withdrawal at 0200, asking students to assess withdrawal, manage pain and respond when the patient says he is leaving. In Community Health, students will join the county health department's naloxone distribution events and learn to teach its use. The thread adds about ten hours across the program, displaces little and builds from knowledge to bedside skills to community practice.
The program will evaluate the thread in three ways. Students will complete the same attitude scale used by Crook et al. (2025) at the start of Mental Health and at the end of the program. Faculty will score the Adult Health II simulation against a rubric for withdrawal assessment, pain management and response to a patient who wants to leave. And the hub hospital will be asked to share, for its medical units, the proportion of patients with opioid use disorder who leave against medical advice, a measure the program cannot claim to change alone but should watch as its graduates join those units.
References
American Association of Colleges of Nursing. (2021). The Essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/essentials
Crook, J. I., Giordano, N. A., Mathias, J. E., Getz, T., & Febres-Cordero, S. (2025). Evaluating stigma toward individuals with substance use disorder among prelicensure nursing students. Nurse Educator, 50(2), 79-83. https://doi.org/10.1097/NNE.0000000000001770
Finnell, D. S., Sanchez, M., Hansen, B. R., Stevens, A., Savage, C. L., Seale, J. P., & Johnson, J. A. (2022). Changes in nursing students' attitudes and perceptions after receipt of enhanced substance use-related curricular content. Journal of Addictions Nursing, 33(2), 62-69. https://doi.org/10.1097/JAN.0000000000000427
Liebschutz, J. M., Crooks, D., Herman, D., Anderson, B., Tsui, J., Meshesha, L. Z., Dossabhoy, S., & Stein, M. (2014). Buprenorphine treatment for hospitalized, opioid-dependent patients: A randomized clinical trial. JAMA Internal Medicine, 174(8), 1369-1376. https://doi.org/10.1001/jamainternmed.2014.2556
How this NUR 6003 Module 4 example is structured
NUR 6003 Module 4 in many sections analyzes a community need that a nursing program should address; your classroom's instructions decide the need and the scope. This example defines the need with local data, connects it to what graduates will face in practice, uses evidence on outcomes and on learners, audits the current curriculum and proposes specific changes with an evaluation.
NUR6003 Module 4 questions, answered
What does NUR6003 Module 4 usually ask for?
NUR6003 Module 4 in many sections asks you to analyze a community or societal need and explain how a nursing program should respond through its curriculum. Your classroom's instructions decide the need and the scope.
Where do I find data on community needs?
Start with the community health needs assessment published by local hospitals and health departments, then add hospital or public health data that show how the need reaches nursing practice.
Should the response be a new course?
Not necessarily. Threading content through existing courses is often more realistic and builds competence progressively. Explain why your chosen response fits the need and the program.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.