Trustworthiness was supported in each step of the dataanalysis process. First, in the preparation phase, we craftedour open-ended question in such a manner to allow therespondent to offer a wide variety of descriptions. We pur-posefully did not limit it to their personal experiences withSU and opened the experiences to more broadly encom-pass a lived experience surrounding substances. Stratifiedrandom sampling in the parent study allowed us to repre-sent the larger population of RNs in the state. Second, inthe organization phase, the three coders used printed cop-ies of the documents to allow for conceptual tools, such ascolor coding of the responses. Multiple discussions of thetemporal patterns, number of categories and concepts, andthe order of the themes transpired. In the reporting phase,several iterations of final themes, supported by narratives,were reviewed.

Quantitative AnalysisAs the objective of the current study was to explorenurses’ responses related to SU, we present descriptivestatistics in Table 1 and comparison statistics (α = .05) ofthose nurses who offered comments and those whodeclined. The p value was obtained using chi-square testor Fisher’s exact test for categorical variables and two-sample t test for continuous variables. Of note is that theASSIST (WHO ASSIST Working Group, 2002) surveyresponses indicate a very low rate of SU (self-report) andno statistical differences were found between contribu-tors/noncontributors in SU (tobacco, alcohol, and othersubstances). However, as outlined in the results section,the qualitative analysis reveals themes that describe thisphenomenon in nursing.