The Impact of Socialization Factors on the Prevalence of Substance Use/Abuse by Student Nurses in Limpopo College of Nurses (LCN), South Africa

Received: 15-Dec-2020;Accepted Date: Jan 18, 2021; Published: 25-Jan-2021

Introduction

Substances affect all sectors of society in all countries, in particular, substance use affects the freedom and development of young people. This is despite considerable health and social impact associated with them. Substance use induction rates for students rise quickly at first level in tertiary institutions. There is a strong relationship between substance use by student nurses who are mostly youths and many social, emotional, and behavioural problems, such as fighting, stealing, driving under the influence, absenteeism, termination of training, poor performance, and damaging properties [1]. It is possibly uncontroversial to affirm that all tertiary campuses struggle with controlling substance use by students.

The age at which students first enter such tertiary institutions is an age of freedom and experimentation. Student nurses tend to have the opportunity to test the limits previously set by the parents at their homes and secondary institutions. In tertiary institutions drinking alcohol was reported to be higher among new students, especially during the orientation programme [2]. This is where all levels meet and spend the night having fun. No research-based evidence or information is emanating from the Colleges of Nursing in this respect.

It has been noted that students who use substances always disobey school rules and regulations [3]. Substance use in tertiary institutions has become a global scourge affecting almost every country, including South Africa (SA) and Limpopo College of Nursing (LCN). The most commonly used substances are cigarettes, illegal drugs and alcohol. However, alcohol use is increasingly becoming a public health concern. Marijuana is the most commonly used illicit substance amongst youth [4]. The College is faced with a challenge due to nonexistent initiatives to reduce substance use and facilities for treatment. Despite the country’s concern, education and intensified campaigns about the dangers of substance use, most students do not care [2].

Substance use by student nurses at LCN is a serious problem affecting student nurses, lecturers, student affairs officers and some family members.

This study evolved from the researcher’s observation as one of the lecturers at one of the nursing campuses in LCN. During theoretical (block) and clinical (practical) exposure, the researcher identified a trend of absenteeism and poor academic performance by some student nurses (Clinical and theoretical attendance registers, Remedial teaching books). Observations were supported by remarks from some student nurses who alleged that their colleagues are not reporting for class/duty due to substance use. According to the researcher’s view, one per cent of attrition rate is a loss at LCN because each student is irreplaceable. Another student missed practical examinations because of absenteeism related to the use of substances.

Although excessive use of substances is prevalent among the student nurses, there is no known study conducted in LCN, therefore the study sought to investigate the factors influencing substance use by student nurses in LCN. This challenge calls for a multidisciplinary approach pursuing demand, and supply. However, research and monitoring of substances control must continue to develop a model, policies and interventions to decrease the prevalence of substance use by student nurses an LCN.

Method

Design

A qualitative method was used in this study, the exploratory-descriptive research design was employed, to explore the participants’ perceptions, perspectives and understanding on the impact of socialization factors on the prevalence of substance use/abuse by student nurses at LCN. Six Focus group discussions and in-depth were utilized. This design allows for a deep understanding of participants thoughts, opinions and experiences [5-7].

Setting

The study setting was the Limpopo College of Nursing in South Africa. In each district, there is a campus, namely: Giyani in Mopani, Sekhukhune in Sekhukhune, and Sovenga in Capricorn Thohoyandou in Vhembe and Waterberg campus in Waterberg district. Hence, all the campuses were accessed with few or no restrictions, but with the strict principles of ethical consideration.

Population and Sampling

The study population comprised of student nurses from level I to level IV, males and females, users and nonusers. Purposive and snowballing sampling techniques were used to select lecturers and all students registered for R425 course in five campuses under the LCN and yielded seventy-five (75) students. All these campuses have similar characteristics. The total number of participants was determined by data saturation. The participants who were recruited using snowball sampling were the nursing students who were particularly known to be substance users.

Data collection and analysis

Data were collected from six (6) focus groups, each having ten to fifteen participants. In-depth interviews were also conducted to some lecturers. Interviews took place in a private and quiet environment. Qualitative data were analyzed and classified into logical thematic categories. Analysis of data collected during focus group interviews was an ongoing process, where emerging themes were categorized based on the research questions. All audio-recorded Focus Group Discussions and in-depth interview were transcribed verbatim. The researcher also listened to the participants’ verbal descriptions of the transcribed data and audiotapes. Data analysis and data collection occurred concurrently [5-7].

Measures to ensure trustworthiness

Credibility was ensured by spending more time with the participants. The voice- recorder, observational notes and interview was used to enhance the truthfulness of the data. To ensure transferability the researcher selected information-rich participants through purposive sampling. Dependability was achieved by allowing crosschecking of codes also known as intercoder agreement by other research experts to see whether the experts would code the data in the same way as the researcher. To ensure confirmability the researcher also sent the findings to experts, and promoters to read the findings and confirm.

Ethical considerations

Ethical clearance was granted by the University of Venda Higher Degree’s Committee (SHS/17/PDC/11/0505). Provincial Department of Health and Vice–Principals of all five Campuses granted permission. A written informed consent form was obtained from each participant before the interviews. Participation in this study was voluntary. Participants were assured of anonymity, and no information shall be shared with unauthorised persons.

Results

Demographic characteristics of participants

The demographic characteristics of participants in the focus groups consist of students from all the campuses. Age between eighteen and twenty-five years, both males and females. Six groups of students between ten and fifteen were interviewed.

Qualitative findings

The results revealed that the consequences of socialization contribute to the prevalence of substance use/abuse among the students. Four themes and subthemes emerged during the interview: family background, household poverty experience, single-parenthood background, low self-esteem, as well as traditional practices and values. From each theme sub-themes emerged (Table 1).

Table 1: Theme and sub-themes.

Family background: Family background emerged as a first the under which two sub-themes emerged namely parents’ usage of substances and household poverty.

Parents’ usage of substances:

Evidence indicates that the common reason behind the prevalence of substance use/abuse relates to the parents and/or guardians’ use the substances. The impact of parents’ usage constituted severe factors that lead the students’ substance use/abuse. Observing usage behaviour created the room of influence on the students to indulge in the usage. This was said by a lecturer, who said: “To me, family plays a big role in influencing substance use/ abuse. I would say in case a student is raised by family members who drink alcohol or smoke cigarettes he/she is at risk of doing the same thing. One of the students told me that he started to smoke because his father used to send him to buy the stuff (marijuana or dagga) for him’’ (Participant 1; Lecturer; Female; 65 years). The findings suggest that the prevalence of substance abuse resulted out of the parents’ usage. The student learned how to use the substance because he was involved in the purchase of substances for his father.

Family’s negligent attitude towards substance use/ abuse:

The study revealed that family’s careless attitude on the prevalence of substance use/abuse. The indication was that most students were raised in families where attitudes towards substance usages were not monitored or supervised. One participant highlighted that grandparenthood feckless was a contributory factor to the prevalence of substance use/abuse by students. This was evidenced by the following statement: “Family carelessness is a major problem leading to students in substance use/ abuse. You will be surprised that for some students, no one ever told them not to smoke or drink alcohol at an early age. They did not caution or apprehended when they do it. In a way, I don’t blame the students, because some of them grew up under their grandparents’ roof…. (Participant 2; staff member; male; 53 years).

Another participant stated the following: “I have been drinking and smoking long before I started nursing, I and my siblings use to smoke and drink. With no restrictions” (Male student [2]; 21 years; level 1)

Household poverty

The evidence that emerges from the thesis indicated that students’ parents’ income played a significant role in the prevalence of substance use. It was revealed that the students who are involved in substance abuse come from homes whereby parents were mostly unemployed. Some participants reported as follows: “My dad is a retired policeman. He is very old. My mother used to be a primary school teacher. But now they don’t work. This is frustrating because sometimes I have to support my siblings, hence I am drinking” (Male student [4]; 22 years; level 3). Other lecturers indicated that low-income earning households played a role in the use of substances among the students.

Single-parenthood: Based on the thesis results, singleparent homes contributed to substance use/abuse among the students in LCN. Female-headed homes emerged as a sub-theme.

Female-headed homes

It was indicated that female-headed homes were one of the leading factors behind the prevalence of substance use/abuse. It was suggested that students who abuse substances were from female-headed homes, headed either by their mothers or grandmothers. One participant indicated that: “I know a few students who are heavily involved in substance use/abuse. I can confirm that these boys and even the girls I know are living with their mothers and grandmothers. So they live in homes with no proper male authority.” (Participant 6; female; 50 years)

Low self-esteem: Low self-esteem played a role in the prevalence of substance use/abuse among students and was seemingly associated with the need or desire for identity and recognition.

The need/desire for identity and recognition

The evidence suggests that the students’ quests for esteem contributed to the prevalence of substance use. During the interview, students involved in substance use/ abuse stated their motives as: “I started drinking alcohol on our fresher’s ball party to be able to reduce being shy and make new friends. I met some senior friends that I really like and they were all drinking and smoking (Male student [5]; 24 years; level 3). Another participant stated the following: “Before I started drinking and smoking to ease my anxiety, I used to think drinking is for senior people, big girls and their boyfriends, so I drink cider to boost my esteem…..” (Female student [11]; 24 years; level 4). Behaviours such poor sense of well-being, as well as low self-esteem, makes the youth give in to substance use/abuse.

Traditional practices and values: The traditional practices and values were incorporating traditional or cultural events as a sub-theme.

Traditional/cultural events

The results revealed that traditional practices and values played a role in the prevalence of substance use/abuse among students. Traditional practices that bordered on the use of alcohol for its rituals gave youths the opportunity of using substances alongside the elders. Evidence revealed that the youngest boys and girls of the family get an opportunity to engage in substance use during such traditional ceremonies. A male participant uttered the following: “There are times when our members come together for a family reunion. Our parents would cook and brew sorghum beer. My siblings and relatives started drinking from our family reunions” (Male student [08]; 22 years; level 3). Another participant stated that: “My first encounter with drinking and smoking marijuana was when I returned from initiation school. Coming back from initiation school we also drank home-brewed beer with no restrictions; later I bought my own drink, but I don’t drink every day” (Male student [05]; 20 years; level 1)

Another implication of the study is the fact that during family gathering parents are not bothered by their children’s substance use, even if they are perceived as youngsters. The fact that substances (alcohol and cigarette) are kept in abundance being not supervised that makes them contributors to their children, whether parents were aware that their children were partaking in alcohol consumption.

Discussion

The study explored the impact of socialization factors on the prevalence of substance abuse by among the student nurses at LCN. Results revealed that student’s families exemplify the primary setting in which their lives were shaped and developed. The results suggest that the family unit as the first socialization agent had a strong and continuous impact of substance addiction experience which is further externalized to other settings such as the colleges. The fundamental contributors to developing substance use/abuse are mostly within an individual developmental feature.

Notably, children from intact families used meaningfully fewer substances than children from single-parent families [8-11]. Other studies argued that poverty-stricken environments leave many experiencing lifestyles which include substance use/abuse [12-15]. Household poverty is a vicious cycle that perpetuates itself as generations are born and raised in lifestyles of high-risk exposure. The same social aspect focused at the societal level, that looks at how factors such as poverty, unemployment, community tolerance on substances, slack border controls, etc., place the youth at risk to substance abuse. Several studies are confirming that these factors have contributed to rising levels of substance abuse in South Africa through widespread and severe poverty levels [16- 26]. The literature presents that there is a link between substance use and poverty though there is an argument that substance use can be the cause of poverty [10, 25, 27-29]. Low-income earnings, unemployed family members, and parents depending on the social grant are associated with poverty. Poverty creates a particular link on the prevalence of substance use/abuse [26, 30-34].

The researcher’s view is that single-parent households have an impact that heightens the vulnerabilities of students on the prevalence of substance usage and abuse. This home system denies a student the benefits of positive balanced parenting experiences built on the principle of father and mother. There is available evidence that indicates adolescents from single-parent households are more prone to delinquent behaviours, including drug and alcohol use [8, 35, 36]. The notion of positive balanced parenting typically underscored activities such as, nurturing behaviour, which are activities that respond to the child’s needs for emotional security, the provision of warmth and sensitivity embedded within the structure of the father and mother relationship. For instance, in a household composed of the father, mother, and children, there is a natural ‘parental structure’ that cultivates behavioural expectations. The literature further highlights that a parent or a close relative, such as a sibling, who use substances, increases an individual risk of substance use/ abuse [8, 10, 11, 37-40].

Parental structure implies setting boundaries and guiding the child’s behaviour through modelling of positive behaviours, without physical or psychological coercion from both father and mother perspective. Being raised in a female-headed home, as a young boy/girl, has consequences not only on a socio-economic basis but also lessen the social skills. Lack of a paternal sense of balance mostly in female-headed households constitutes a particular risk behavioural factor including the vulnerability to substance use/abuse.

The results indicate that the students’ low self-esteem contributes to the prevalence of substance usage and abuse in LCN. The implication of these results suggests that the need to attain social high esteem was an indication of the students’ involvement with substance usage and abuse. These findings further indicate that the pattern of socialization on college premises is deemed risky because it shows the students vulnerability to negotiate high selfesteem with involvement in substance usage. It had been noted that low self-esteem influences an individual’s use/abuse of substances [3]. The findings concluded that some of those students who use substances have lower self-esteem compared with other colleagues.

Evidence indicates that substance usage occurred in traditional events revealed the role of culture on the prevalence of the abuse. For instance, the main idea behind the initiation schools is to teach young ones how to behave responsibly and be exemplary. Those are the main ideas that are behind the traditional initiation schools. It is still unclear, the reason for the ideological change to become an entry that promotes or allowed substance use for underage. Findings show that returnees of the initiations are becoming prone to substance use/abuse. Traditional practices allow youths to use substances without restrictions, and they end up being abusers of substances. Furthermore, the use of homebrewed substances was meant for family events which in turn results in substance abuse [41].

The socialization factors come under social influences that favour substance use/abuse among individuals with low socioeconomic status and minimal parental education, family conflict, weak family bonds, low parental supervision [1, 42-48]. Evidence confirmed that substance use may result in unacceptable sexual behaviour, hence unplanned pregnancies and sexually transmitted infections among students. Consequently, school learners who abuse substances are more likely to engage in promiscuous behaviours such as sleeping with different partners [49].

Limitations of the Study

The study was conducted in one College of Nursing with a purposive sample of lecturers and student nurses. This limits the generalizability of the findings to a wider range of nursing colleges or even other nursing campuses around South Africa.

Recommendations

The authors recommend the provision of Substance use Health promotion programmes and services through inter-sectoral collaboration and inter-organizational partnerships, community participation as well as community engagement. Constructive media-based public education campaigns: The media needs to play a constructive role in preventing substance use by the youth to ensure that appropriate messages are designed and communicated through audience targeting. This should be strengthened by substance abuse control and media policies. The Departments of Social Development, Health and Education should consider improving the implementation of school-based prevention programmes with special focus on reinforcing “Ke Moja, No thanks I am fine without drugs” programme.

Furthermore, recreational facilities should be developed in deprived communities to keep the youth engaged and as a substitute for focusing on drug-related ventures. The family structure needs to be strengthened and empowered with the knowledge to instil positive norms and values which will discourage youth from substance use. Further research should be conducted on the impact of parenting approaches on substance use by young people.

Conclusions

Substance use by student nurses found to be a problem in all campuses of the LCN which is causing distress to student nurses, lecturers, student affairs officers, families as well as the government. The substance use was found to be fuelled by socialization issues such as family background, household poverty, traditional practices, parenting approaches, need for belonging and recognition, single-parent household and low selfesteem. The provision of interventions to curb this challenge calls for a multidisciplinary and multisectoral approach. The researcher recommended approaches that target the students, families, college and the community.

Acknowledgements

The authors would like to thank lecturers and all student nurses who participated in the study.

Competing Interests

The authors declare that they have no conflict of interest.

Source of Funding

The publication of this paper was funded by the University of Venda Research and Publication Committee (RPC).

Disclaimer

The views expressed in this article are the authors’, and not an official position of any of the institutions affiliated with the authors.

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