ABSTRACT

Objective: Identify the academic interest related to the therapeutic use of cannabis (TUC) in Nursing students from a private university in Chile. Methods:A descriptive, exploratory study was carried out with a qualitative approach from Gadamer's hermeneutic paradigm. The non-probabilistic sample of cases by criteria comprised 20 key informants of the 3rd and 4th year of the Nursing career, including enrolled students in the school year. Data collection was through the formation of two focus groups in 2018. Data reduction was manual, transcription was performed using the Jefferson formula, and rigorous and ethical criteria were met. Results:3 categories emerged: academic node, disciplinary roles, and ethical-legal considerations. The students acknowledge linking the therapeutic use of cannabis to their curriculum, displaying relationships between it and its environment in the disciplinary functions related to the assistance role in care management and the educational role; they visualize it towards the community and consider the lack of research in the area, bioethics and legal aspects are mentioned for the third category. Conclusions:There is academic interest in incorporating the TUC within university education, acknowledging assistance action, the educational role, and the relationship with strategies and interventions towards the population; is also observed lack of research development administrative management is not mentioned. In addition, bioethics and legal aspects need to be involved in training regarding TUC.

Keywords: Cannabinoids; Cannabis; Pain; Nervous System Diseases. (Source: MeSH NLM)

RESUMEN

Objetivo: Identificar el interés académico relacionado con uso terapéutico de cannabis (UTC) en estudiantes de Enfermería de una universidad privada de Chile. Métodos: Se realizó un estudio descriptivo, exploratorio, con enfoque cualitativo, desde el paradigma hermenéutico de Gadamer. La muestra no probabilística de casos por criterios se conformó de 20 informantes claves de 3º y 4º año de la carrera de Enfermería incluyéndose a estudiantes matriculados en el año lectivo. La recolección de datos fue mediante la conformación de dos grupos focales en el año 2018. La reducción de datos fue de tipo manual, la transcripción de datos se realizó mediante la fórmula de Jefferson, se cumplió con criterios de rigor y éticos. Resultados: Emergieron 3 categorías: Nódulo académico, roles disciplinares y consideraciones ético-legales. Los estudiantes reconocen vincular el uso terapéutico de cannabis a su curriculum, desplegando relaciones de este y su entorno en las funciones disciplinares relativas al rol asistencial en la gestión del cuidado, del rol educativo, lo visualizan hacia la comunidad y consideran falta de investigaciones en el área, bioética y aspectos legales son mencionados para la tercera categoría. Conclusiones:  Existe interés académico de incorporar el UTC dentro de la formación universitaria, reconociéndose la acción asistencial, el rol educativo y la relación con estrategias e intervenciones hacia la población; se observa también falta de desarrollo investigativo y no se menciona la gestión administrativa. Además, se necesita involucrar la bioética y los aspectos legales en la formación respecto del UTC.

Palabras clave:Palabras Clave: Cannabinoides; Cannabis; Dolor; Enfermedades del sistema nervioso. (Fuente: DeCS BIREME)

INTRODUCTION

The therapeutic use of cannabis (TUC) is understood as the modality of use of this plant or its derivatives to alleviate symptoms, treat a state or a medical condition ⁽¹⁾. Drugs that are in clinical practice are derivatives of cannabinoids. They are used for pain, degenerative and non-degenerative neurological diseases, cancer, glaucoma, states of patients with human immunodeficiency virus (HIV), problems presented by chemotherapy and radiotherapy, psychiatric pathologies, gastrointestinal pathologies, sleep disorders, among others ^(2,5).

Due to its implications in the health field, reflections and questions arise about the role that corresponds to the disciplines and health professionals on this topic, particularly to the nurses seen in the therapeutic approach, clinical management, and implementation. progress of educational, care, administrative, and investigative interventions, with an eye on future patients directed at the axis of care ^(67,8). It is important to answer questions that will arise at the social, political, cultural, economic, academic, judicial, and religious levels ⁽⁶⁾ and even others of a global nature; for this reason, it is necessary to investigate these fields since they concern to nursing and closely related to the academic field, where the professional spectrum is modeled, and training on these issues is necessary⁽⁷⁾ .

In the professional and academic field of nursing, there is debate as to whether there is enough empirical evidence to support the decision of the TUC ^(8,9). This is not alien to the students either, since they can agree to freely raise their respective views or opinions that allow them to develop their potential and skills, especially when they are in training ^(10,11). Based on the above, starting with these approaches sheds light on new visions in a little-explored field, generating answers that can be received positively to generate new demands in the disciplinary field, especially in care management^(8,10).

In Chile, in 2015, the Chamber of Deputies approved the bill that decriminalizes the cultivation of marijuana and also its private consumption (Law 20,000), for spiritual, medicinal, and recreational purposes; it also contemplates that people who need to consume marijuana for medicinal purposes must have a medical prescription ⁽⁷⁾.

Nurses have the opportunity to educate and monitor TUC; they are ethically obligated to support patients and must overcome stigmas and fears around its use, often facing legal and professional dilemmas^(12,13). This scenario can be modified through empowerment and knowledge, the acquisition of respective training⁽⁷⁾, visibility of clinical, care, legislative, and legal aspects, and promoting a positive perspective regarding cannabis from the therapeutic aspect; In addition, they have the responsibility of being up to date and knowing the medications that patients receive, including cannabis in all its forms of consumption ^(12,17).

From the academic point of view, some studies support the TUC, justifying potential benefits for patients with various clinical ailments ^{(8,18,19,20,21-23)}.

Therefore, the need arises to place it in a current discussion and consider the student opinion on academic interests as an initial measure of the TUC to reformulate educational instances or disciplinary strategies that aim at the direct care of future patients who will surely be under the care of nurses. In addition, they must lead these spaces, investigate and implement public policies related to this issue in the different disciplinary roles and start with these questions from the academy ^(7,9).

There is little research development, especially from an academic perspective; this involves opening a new area and exploring post-development nursing in this aspect⁽⁷⁾. Therefore, it is necessary to know opinions regarding this field and promote knowledge of it as a disciplinary duty since always being at the forefront of new challenges shows how care is always a continuum and worthy of validation from different angles. Therefore, this study aims to describe the academic interest related to the therapeutic use of cannabis in Nursing students at Universidad Mayor.

METHODS

Design and study area

A descriptive, exploratory study was carried out, with a qualitative approach framed from Gadamer's interpretative, hermeneutic paradigm ^(24,25). The interpretation and hermeneutic understanding of the narrative of reality presented is in charge of rescuing the notion of intersubjectivity and understanding of the interpersonal relationship.

Population and sample

The study population consisted of 324 Nursing students from the Universidad Mayor, a private university in Santiago, Chile, in 2018. The non-probabilistic sample of cases by criterion ⁽²⁶⁾, was made up of 20 participants who were studying 3rd and 4th year of Nursing degrees. The inclusion criteria were being a student enrolled in the school year, having time availability, agreeing to voluntarily participate in the study, and previously signing the informed consent. Exchange students were excluded ⁽²⁶⁾.

Concerning the transferability of the research, it allows leaving spaces to replicate this study in another national or international educational reality, obtaining similar or different results in order to promote the subject investigated and thus stimulate and discover knowledge in these perspectives in pro-disciplinary ⁽²⁶⁾.

Variables and instruments

The technique was the interview, a guideline script designed by the author and validated by an external agent was used, which included guiding questions based on the proposed objective.

Procedures

For data collection, the formation of focus groups was used ⁽²⁶⁾; For this reason, two groups of 10 participants each were formed (a group of 10 students for the third year and another group of 10 students for the fourth year). The sessions at the university campus lasted 90 minutes, counting for this with a guideline script. One of the questions that were asked and that were part of the question frame indicated: What kind of academic interest do you think nursing students have in relation to the therapeutic use of cannabis? The information recording was compiled through field notes and digital audio recordings; at the time of evidence of data saturation ⁽²⁶⁾, the moment of the field trip was then decided.

Analysis

For the data analysis, the following steps were carried out: audio transcription, these were entered into Word files, then the data reduction process (open coding) and collection of categories, subcategories, and codes of the data provided in the groups were carried out. focal, this is modeled under the modality of Glaser and Strauss ⁽²⁶⁾. For purposes of transcription, the coding modality was used under the proposals of Jefferson ⁽²⁷⁾.

Ethical aspects

The investigation was scientifically protected using Guba's rigor criteria, from which credibility or authenticity stands out since, in this investigation, it is possible to demonstrate sentences or opinions as they are issued or perceived by the subjects in such a way that the results generated in the achievement or verification of new theories in the same or a similar line ⁽²⁶⁾. To safeguard this criterion, the researcher triangulation technique was used and by method, through the incorporation of two invited researchers, who participated throughout the process, in addition to the triangulation of data sources, since it considered ⁽²⁶⁾ students.

Regarding the analysis of ethical rigor, the postulates of Ezequiel Emanuel ⁽²⁸⁾ were considered; the requirement of "Respect for registered subjects" is highlighted, framed in this investigation in the decision to participate, withdraw without penalty, maintain the privacy and confidentiality of this, guidelines and application of informed consent and recognition of the contribution of the participating subjects. Finally, the research had the approval of the scientific Ethics Committee of the university, with resolution No. 0059 of the year 2018.

RESULTS

Of the 20 participants called for the study, 14 were female, and 6 were male. After carrying out the data analysis, three categories emerge academic node, disciplinary roles, and ethical-legal considerations.

When carrying out the analysis of the first category, "Academic Node," the interviewees agree with the relevance of including the TUC in the curriculum directed towards the subject of pharmacology, where they indicate that it would be pertinent to assess both pharmacological aspects and adverse reactions, contraindications, care in overdose, effects of this, use, dosages among others, in the same way, they value that this action is taken into account to improve skills in new drugs. The most frequently mentioned reports were those related to the curriculum to insert the subject into their academic training, evidencing a willingness to get involved with new affordable drugs in the near future and safely for their clinical management with good theoretical bases (Table 1).

In relation to the "professional roles" as a second category, the interviewees allude to the care role with greater preponderance, followed by the teaching role where there is progress towards the community and finally the research role pointing out that there is a lack of greater knowledge in this field. Although it is true in qualitative correlation the reports are very similar; it should be noted that the most emerging is the care, managing to be placed in the first instance. This is due to the fact that students recognize this role more closely in clinical spaces. In this place, they believe they can exercise care actions with enough strength in their speeches while mentioning disciplinary action and management of this with vitality in the near future.

Secondly, the educational role also appears powerful in their speeches, oriented towards a fairly clear action of the professional role and their work in these fields, an investigative activity, according to the statements of the interviewees, deserves merit, since they themselves show a lack of this action. It is worth mentioning that the administrative role was not mentioned (Table 2.).

In the third line of the metacategories "ethical-legal considerations of the TUC", the interviewees believe it is necessary to place a quota for ethical training because it would seem that they would be biased by the interaction with the community and their beliefs regarding usefulness and benefits. Knowing legislative aspects becomes important in this group, how they appreciate or see the need to acquire this knowledge to improve the professional field. According to the speeches, the legal aspects focused on the clinical field stand out. It is of interest for the interviewees to know the prevailing laws and how far they should go as professionals in these interventions, which demarcates that not only the clinical aspect is important, but that it goes further safeguarding legal space for them and for the patient. Finally, ethical aspects were mentioned in a lower category (Table 3).

DISCUSSION

Concerning the academic nodule, the interviewees give strong voices that support the need to incorporate the TUC into the curriculum ^(9,29,30). In fact, there are international investigations that guarantee this position, in which they indicate that nursing students showed a clear lack of knowledge about TUC and the risks associated with it, which are consistent with the results of this research; the importance of incorporating the TUC in the academic and clinical study plans is highlighted, also agreeing with other authors ^(7,29,30)

The incorporation of TUC in the subject of Pharmacology is frequently mentioned, this denotes that this group associates the curricular contents with a particular subject from which they expect knowledge to be developed in this area as an effective formative element to face in the near future the need for professional requirements based on user care ^(19,23).

From the point of view of the disciplinary roles evidenced in this research, it can be argued that the healthcare role is born with a certain clamor, imposing a challenge on future interventions that will surely have to emerge after the drug(s) derived from cannabis are approved and put into practice. in progress in the actions of public or private health and of course, with the nursing perspective in all actions to be developed under this role ^(13,29,30). In addition, a disciplinary challenge is perceived since it would be necessary to be updated with these events at all levels of health where the control, monitoring, and actions of users would always be present in the logic of quality in care and care management. ^(12-20,29). This creates a challenge for future interventions that should emerge after cannabis-derived drugs are approved and used for public or private health ^(7,29,30).

The educational role is mentioned as the second subcategory in the disciplinary roles; there is a glimpse of the need to incorporate it into this action not only in nursing but directing it towards the family and community, where the TUC is still at a disadvantage, they visualize an important field and emergent. The students allude to strategies or interventions towards this focus, and a good role in future progress emerges, this being a spring of appropriation of an eventual development in this role; this is consistent with other researchers who have denoted the same ^(8,12,13,18)

Research as the last subcategory in this range, is another aspect to be considered by students who indicate that there is indeed a need for more development and promotion in this area because it is new and, therefore, they argue that it is a duty to be updated and explore new challenges ^(4,8,9).

Regarding the "ethical-legal considerations" as the last category, the students allude to two patent visions: ethics and the legal aspects involved in it. From the first, it can be said that the interviewees state the need to incorporate this topic in bioethical training, which is consistent with other investigations ^(7,12,13). Second, it can be argued that this group is internalized in learning and applying the existing laws regarding the TUC in order to act effectively in regard to the care, management, and attention of the user, indicating a high commitment to the law and its scope. placing the TUC in a medicinal look and not for recreational purposes. This allows us to observe the ability to recognize the differences between one or the other use; then it can be said that the students relate not only to the clinical environment but they are able to establish links with the laws issued in the prevailing health policy regarding the TUC to facilitate it to all participating actors and exercise regulations accordingly ^(7,12-14).

It is noteworthy that this research does not mention at any time elements of the registry or the administrative tools that could appear after the drugs become more visible in the direct care of users; there are already recognized guidelines in other regions of the world ^(14,18) while seeming more developed.

The limitations of the study were oriented to the little support received by the university for this research, which did not have funding, which shows the lack of interest in this topic as important as the TUC, and that contrasts with the interest of the students themselves.

CONCLUSIONS

There is academic interest in incorporating the TUC within university education, recognizing the assistance action, the educational role, and its relationship with strategies and interventions toward the population. In addition, the lack of research development is observed and administrative management is not mentioned. The need to involve bioethics and legal aspects in training regarding the TUC is referred to.

Thanks: To the participating students of the Nursing career of the Universidad Mayor de Temuco and to the group of teachers of the subject of Nursing Research Methodology who were part of the 2020-2021 squad.

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