Benchmark – Evidence-Based Practice Project: PICOT Paper

NUR-550 Benchmark – Evidence-Based Practice Project: PICOT Paper

Alcohol use disorder (AUD) remains a challenging problem for many Americans aged over eighteen years. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol use disorder (AUD) entails a condition characterized by inability to stop or control use of alcohol despite the adverse social, occupational and health effects. Nurse practitioners, especially psychiatry nurses, have a responsibility to develop evidence-based care interventions to help patients with AUD (Rombouts et al., 2019). The NIAA asserts that close to 15 million individuals in the country suffer from AUD. The purpose of this paper is to describe the PICOT for the evidence-based practice proposal for AUD interventions.

PICOT Question/Statement

In individuals from low socioeconomic status and poor educational levels suffering from alcohol use disorder (AUD) (P), does offering behavioral treatments and coordinated care with other providers (I) compared to non-interventions (C) lead to improvement in handling of alcohol withdrawal symptoms and treatment of alcohol use disorder (0) within 12 months (T)?

Population’s Demographic and Health Concerns

The population demographic affected by the problem include an estimated 15 million individuals that suffer from AUD. Close to 5.8 percent or about 14.4 million adults aged 18 and above had the condition in 2018. According to the figures, about 9.2 million were men while women were about 5.3 million. The report also shows that about 400,0000 adolescents aged 12 to 17 years had AUD over the same period (NIAAA, n.d). The implication is that millions of individuals suffer from alcohol use disorder and demonstrate a host of symptoms that are diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Description of Proposed Evidence-based Intervention and Incorporation of Health Policies and Goals

The need to shed light on barriers to provision of quality nursing care for patients with alcohol use disorder (AUD) and enhancing clinical competencies for the care of hospitalized patients with AUD is essential in addressing the problem. In their study, Witkiewitz et al. (2019) observe that clinicians should leverage advances in science and treatment as one of the ways to address the existing barriers and improving competencies in caring for these individuals. Shedding light on barriers to provision of quality care entails knowing the challenges that clinicians and other providers face in their efforts to offer treatment to these indi

Benchmark  Evidence Based Practice Project PICOT Paper
Benchmark  Evidence Based Practice Project PICOT Paper

viduals. Alcohol use disorders are considered as some of the most prevalent mental disorders, particularly in high and upper-middle-income nations and lead to increased disease burden and mortality occasioned by medical complications and consequences (Leggio & Lee, 2017). Therefore, the project will entail having interventions that allow clinicians to understand the complex nature of the condition and the associated factors.

The incorporation of health policies and goals is an essential component of evidence-based practice projects. In this case, the project

Benchmark - Evidence-Based Practice Project PICOT Paper
Benchmark – Evidence-Based Practice Project PICOT Paper

incorporates the use of health policies like the need to increase accessibility to mental health services to diverse populations and lowering the disease burden associated with AUD. The goal of this project is to ensure that clinicians not only understand the challenges but can develop responsive actions to address the issue. A core aspect of the project is to enhance competencies for the clinicians as they handle patients with AUD.

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Comparison of the Intervention to Previous Research or Practice

Behavioral treatment and incorporation of coordinated care are the main interventions that the project will deploy in addressing the problem. Studies show that that behavioral therapies are essential treatment options of individuals with AUD. While there are medications approved by the Food and Drug Administration (FDA) for alcohol use disorder, the deployment of new treatment interventions like behavioral approaches can help these individuals get better outcomes. Again, the intervention compares favorably with past research and practice since many clinicians are leveraging existing evidence-based practice interventions to develop care plans based on behavioral treatment approaches to offer care to individuals with AUD. In their study, Patel and Balasanova (2021) assert that behavioral treatment using cognitive behavior therapy can assist in managing the trigger, providing support and addressing issues and concerns associated with mental health due to AUD. The implication is that the interventions in this case are supported by existing research studies by different scholars and journals.

Expected Outcomes of the Intervention

As observed by Patel and Balasonava (2021), behavioral treatment offers better outcomes in helping potential addicts or victims to manage factors that can trigger alcohol use. Secondly, while alcohol use disorders are prevalent, they go untreated due to the high stigma linked to them. Further, insufficient systematic screening also exacerbates the situation. Therefore, this project will focus on ensuring that it deals with reducing stigma and ensuring that there is sufficient systematic screening in primary health care to address the problem. The intervention will also focus on enhancing the use of effective and cost-effective psychosocial interventions for better outcomes.

Time to Implement the Intervention and Evaluation of Outcome

The project will implement the interventions over a period of one year or twelve months dealing with individuals suffering from AUD at different stage of diagnoses. At the core of the implementation would be enhancing adherence to behavioral treatment through improved coordination among clinicians who possess the requisite competences and understand the underlying barriers to care provision. The evaluation of the outcomes will rely on improvement in management and control of triggers, enhanced screening in primary care settings, and effective response to treatment of individuals with the condition.

Nursing Science, Social Determinants of Health, Epidemiologic, Genomic and Genetic Data

Nursing science entails the effective use of nurse-based scientific evidence to develop care plans and interventions while social determinants of health denote to factors that affect care delivery and accessibility. The epidemiologic, genomic and genetic data demonstrate the different patterns of the condition and how it affects the selected population. In this case, all these aspects support population health management of the selected population since they demonstrate the existing data, patterns and interventions that can be implemented to help address the issue (Carvalho et al., 2019). The use of nursing science will allow clinicians to deploy evidence-based interventions while social determinants of health demonstrate the most affected demographics and the factors leading to increased disease burden.


The evidence-based practice project is critical to helping nurses and other providers understand the barriers to care provision for this population and the need to enhance their clinical competence in planning for effective care. The project will ensure that patients with AUD get better interventions through behavioral treatment to manage the condition.


Carvalho, A. F., Heilig, M., Perez, A., Probst, C., & Rehm, J. (2019). Alcohol use disorders. The

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Trauma occurs when individuals are overwhelmed by circumstances or events and counters them with extreme horror, fear, and helplessness. Excessive stress overwhelms an individual’s coping capacity. Trauma can stem from exposure to abuse, discrimination, neglect, violence, and accidents (Shalaby & Agyapong, 2020). This paper seeks to describe populations with traumatic experiences and an intervention to address the concern and discuss factors that influence health management.

Population’s Demographics and Health Concerns

According to the National Council for Behavioral Health (NCBH), 70% of adults in the U.S. have experienced a traumatic event at least once. Almost all children who observe a parental homicide or sexual assault will develop Post Traumatic Stress Disorder (PTSD). Likewise, 90% of sexually abused children, 77% who school shootings, and 35% of youths exposed to community violence develop PTSD (NCBH, 2020). Trauma is associated with adverse effects on physical and mental health as well as social and occupational functioning.  Physical effects include headaches, excessive sweating, palpitations, altered bowel patterns, and being easily startled. Mental impact includes fear, anxiety, depression, emotional swings, increased alcohol and drug use, and sleeping difficulties (Mikhail et al., 2018). Furthermore, individuals socially isolate themselves due and have diminished interest in activities.

Proposed Evidence-Based Intervention

The proposed intervention incorporates peer support in trauma-informed care to accelerate the recovery process.  Peer support involves having persons from diverse backgrounds sharing common trauma experiences (Shalaby & Agyapong, 2020). The intervention uses peer support workers, individuals with lived trauma experiences, and who have received special training to be part of the care team. Based on their similar experiences and the shared understanding, patients may trust their peer support worker and be more willing to engage in treatment.

Incorporating peer support supports Healthy People 2020 goal of improving mental health through prevention and ensuring access to appropriate, quality mental health services. The intervention will improve the mental health outcomes of persons with trauma experiences. It will help prevent mental health issues such as anxiety, PTSD, depression, and alcohol and substance use disorders.

Comparison of the Intervention to Previous Practice or Research

Previous practice in trauma-informed care entailed using behavioral health counselors. Crisanti et al. (2019) compared cognitive behavioral therapy intervention groups guided by certified peer support workers with groups led by behavioral health counselors for trauma survivors with PTSD. At six months after baseline, persons in the peer-led sessions had a higher therapeutic alliance and stronger connection than those in the counselor-led sessions. The study shows that peer support can increase patient engagement and ultimately accelerate the recovery process.

Expected Outcome for the Intervention

Incorporating peer support is expected to increase patients’ engagement in treatment and thus accelerating their recovery. Since patients will share their trauma experiences with peer support workers who have experienced similar experiences, it will promote a shared understanding and increase patients’ trust (Shalaby & Agyapong, 2020). Peer support is expected to help patients overcome social isolation caused by trust issues by creating trust between patients and the peer workers.

Time for Implementation and Evaluation of the Outcome

The intervention will be implemented within six months. Patients will be randomly assigned to an intervention or a control group. The intervention group will be assigned to a peer support worker, while the control group will be provided the usual trauma-informed care without peer support. Evaluation will be conducted six months after the implementation of the peer support care. The recovery scores of patients in the intervention group will be compared to those of the control group to evaluate the difference in recovery and outcomes.

Synthesis of Nursing Science, Determinants of Health, and Epidemiologic, Genomic, and Genetic Data in the Management of Population Health

Nursing science is applied to support patients with trauma experiences in line with the principles of safety, respect, and trust. Nursing science is also applied in delivering patient-centered care to improve patient engagement and the quality of trauma-informed care (Fleishman et al., 2019). Social determinants such as living in under-resourced or racially segregated neighborhoods and experiencing food insecurity can result in toxic stress.  Social determinants that should be considered in trauma screening include poverty, neighborhood crime and violence, and racism (Mikhail et al., 2018). Health providers should increase protective factors to mitigate exposure to trauma and environmental factors that contribute to it.

Trauma mainly affects minority racial groups, children, adolescents, and older adults.  The data can be applied in trauma-informed care by emphasizing screening for trauma experiences among high-risk populations. Youssef et al. (2018) found that trauma exposure can be passed to offspring transgenerationally via the epigenetic inheritance mechanism of DNA methylation alterations. The genetic data can be synthesized in trauma-informed care by emphasizing trauma screening to persons whose close relatives were exposed to trauma.


More than 70% of the U.S population has encountered traumatic events such as homicide, sexual assault, shooting, and community violence. Trauma is associated with adverse effects on physical and mental health and impairments in social and occupational functioning. My proposed intervention is to incorporate peer support in trauma-informed care. Peers work together with patients to create relationships where they share their strengths and support each other’s healing. Peer support is expected to increase patient engagement and accelerate recovery. The intervention will be implemented over six months using an intervention and control group.


Crisanti, A., Murray-Krezan, C., & Reno, J. (2019). Are treatment groups led by peers as effective as groups led by counselors for treating posttraumatic stress disorder and substance use disorder?

Fleishman, J., Kamsky, H., & Sundborg, S. (2019). Trauma-informed nursing practice. OJIN: The Online Journal of Issues in Nursing24(2).

Mikhail, J. N., Nemeth, L. S., Mueller, M., Pope, C., & NeSmith, E. G. (2018). The social determinants of trauma: a trauma disparities scoping review and framework. Journal of Trauma Nursing| JTN25(5), 266-281.

National Council for Behavioral Health. (2020, July 17). Trauma Infographic. National Council.

Shalaby, R., & Agyapong, V. (2020). Peer support in mental health: Literature review. JMIR mental health7(6), e15572.

Youssef, N. A., Lockwood, L., Su, S., Hao, G., & Rutten, B. (2018). The Effects of Trauma, with or without PTSD, on the Transgenerational DNA Methylation Alterations in Human Offsprings. Brain sciences8(5), 83.