NUR-550 Evidence-Based Practice Project Proposal: PICOT
NUR-550 Evidence-Based Practice Project Proposal: PICOT
NUR550 Evidence Based Practice Project Proposal PICOT
Complete your PICOT using your approved proposed nursing practice problem. If they were approved, you may use the population
and intervention developed in your Topic 1 assignment. Include any necessary revisions in this submission. Refer to the “Example PICOT” below as needed for guidance on how to complete the PICOT.
| PICOT Question | |||
| P | Population | Individuals suffering from Alcohol Use Disorder aged 18 years and above
Low socioeconomic status and poor educational levels |
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| I | Intervention | Behavioral treatments and coordinated care with other healthcare providers | |
| C | Comparison | Non-interventions | |
| O | Outcome | Improvement in handling withdrawal sysmptoms and treating alcohol use disorder | |
| T | Timeframe | In 12 months | |
| PICOT
Create a complete PICOT 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 (I) lead to improvement in handling of alcohol withdrawal systems and treatment of alcholo use disorder within 12 months (T)?
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| Problem Statement
Create a problem statement for your PICOT. You will use this problem statement throughout your final written paper.
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Statsitics from the National Institute of Alcholo and Alcohlism show that the U.S. looses close to 88,000 individuals due to alcohol associated deaths. These include alcohol-associated traffic fatalities, injuries and health complications like liver diseases and alcoholic pancreatitis (NIAA, n.d). Others succumb to cancer and fetal alcohol spectrum disorders. The implication is that alcohol use disorder is complex to identify and can lead to alcohol withdrawal syndrome (AWS) which is potentially life-threatening (Morgenstern et al., 2020). Nurses are positioned to help individuals with AUD get better and navigate the withdrawal symptoms in a better manner as opposed to potential chances of encountering adverse events and conditions (McCrady et al., 2020). Interventions like brief counseling using motivational interviews regularly and shared decision making concerning different behavioral treatment options can help a multidisciplinary team to help patients with AUD get better outcomes and attain cure for their condition (Witkiewitz et al., 2019). The implication is that nurse practitioners as part of a multidisciplinary team should promote healthy behaviors and self-care interventions and education for patients with AUD and their families to enhance overall outcomes and mitigate the adverse effects of alcohol withdrawal syndrome as these individuals seek effective remedies for their conditions.
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References
McCrady, B. S., Epstein, E. E., & Fokas, K. F. (2020). Treatment interventions for women with alcohol use
disorder. Alcohol Research: Current Reviews, 40(2). DOI:10.35946/arcr.v40.2.08
Morgenstern, J., Kuerbis, A., Shao, S., Padovano, H. T., Levak, S., Vadhan, N. P., & Lynch, K. G. (2021). A
efficacy trial of adaptive interventions for alcohol use disorder. Journal of Substance Abuse Treatment, 123, 108264. https://doi.org/10.1016/j.jsat.2020.108264
National Institute on Alcohol Abuse and Alcoholism (NIAAA). (n.d.). Alcohol Facts and Statistics https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
Witkiewitz, K., Litten, R. Z., & Leggio, L. (2019). Advances in the science and treatment of alcohol use
disorder. Science advances, 5(9), eaax4043. DOI: 10.1126/sciadv.aax4043
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.
Conclusion
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.
References
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? https://doi.org/10.25302/5.2019.ce.12114484
Fleishman, J., Kamsky, H., & Sundborg, S. (2019). Trauma-informed nursing practice. OJIN: The Online Journal of Issues in Nursing, 24(2). https://doi.org/10.3912/OJIN.Vol24No02Man03
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| JTN, 25(5), 266-281.
National Council for Behavioral Health. (2020, July 17). Trauma Infographic. National Council. https://www.thenationalcouncil.org/
Shalaby, R., & Agyapong, V. (2020). Peer support in mental health: Literature review. JMIR mental health, 7(6), e15572. https://doi.org/10.2196/15572
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 sciences, 8(5), 83. https://doi.org/10.3390/brainsci8050083