Examining nurses’ attitudes toward patients who use substances in the hospital setting: A scoping review

Aim: This scoping review aimed to map and describe the existing literature on nurses' attitudes toward hospitalized patients who use substances (PWUS). Design: A scoping review was conducted in accordance with Joanna Briggs Institute (JBI) methodology and reported using the PRISMA-ScR guidelines. Methods: A systematic search was conducted on August 27, 2024, in PubMed, PsycINFO, and CINAHL to identify peer-reviewed studies published in English, between 2014 and 2024. Eligible studies included original qualitative and quantitative research examining nurses' attitudes toward PWUS in hospital settings. Two independent reviewers conducted study selection using a structured screening process. Data were extracted using an author-developed tool capturing study characteristics, including country of origin, aims, methodologies, nursing context, hospital setting, approaches to assessing attitudes, and key findings. Extracted data were synthesized descriptively to map study characteristics, conceptual patterns, and thematic emphases within the literature. Of 1568 abstracts screened, 13 studies met inclusion criteria, with four additional studies identified through citation mining, resulting in 17 included articles. Results: The included literature predominantly described negative attitudes toward PWUS among nurses in hospital settings, alongside recurring thematic emphases related to substance use knowledge and education, challenges in pain management, and perceptions of limited organizational support. Studies varied widely in design, measurement approaches, and geographic context. Findings were organized using Bronfenbrenner's socioecological model to illustrate how nurses' attitudes have been examined across individual, interpersonal, organizational, and societal levels, with most studies concentrated at the micro- and mesolevels. Conclusion: This scoping review maps a growing but methodologically heterogeneous body of literature examining nurses' attitudes toward PWUS in hospital care. The findings highlight conceptual, methodological, and contextual gaps in the existing evidence, particularly related to organizational and macrolevel influences. These gaps highlight important directions for future research aimed at advancing a more comprehensive understanding of nurses' attitudes within hospital-based substance use care.