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NUR-550 Evidence-Based Practice Project Proposal: PICOT

NUR-550 Evidence-Based Practice Project Proposal: PICOT

NUR550 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.

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PICOT Question
P Population Individuals suffering from Alcohol Use Disorder aged 18 years and above

Low socioeconomic status and poor educational levels

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)?

 

 

Problem Statement

Create a problem statement for your PICOT. You will use this problem statement throughout your final written paper.

 

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.

 

 

 

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 Nursing24(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| JTN25(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 health7(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 sciences8(5), 83. https://doi.org/10.3390/brainsci8050083

Rubric Criteria

Total75 points

Criterion

1. Unsatisfactory

2. Insufficient

3. Approaching

4. Acceptable

5. Target

Population (Revision)

Population (Revision)

0 points

The population is not described, or the required revisions were not made for the population description.

4.2 points

NA

4.62 points

Revisions were made accordingly for the population description, but some information or detail is needed for accuracy or clarity.

4.83 points

NA

5.25 points

The population is thoroughly and accurately described. No revision was needed.

Intervention (Revision)

Intervention (Revision)

0 points

The proposed intervention is not described, or the required revisions were not made for the described intervention.

4.8 points

NA

5.28 points

Revisions were made accordingly for the proposed intervention, but some information or detail is needed for accuracy or clarity.

5.52 points

NA

6 points

The proposed intervention is clearly described and relevant to the nursing practice problem and population. No revision was needed.

Comparison

Comparison

0 points

A description of the comparison information is not included.

6 points

A description of the comparison information is incomplete or incorrect.

6.6 points

A description of the comparison information is included but lacks evidence and measurable outcomes.

6.9 points

A description of the comparison information is complete and includes sufficient evidence and measurable outcomes.

7.5 points

A description of the comparison information is extremely thorough with substantial evidence and measurable outcomes.

Outcome

Outcome

0 points

A description of the outcome is not included.

6 points

A description of the outcome is not included.

6.6 points

A description of the outcome is included but lacks evidence.

6.9 points

A description of the outcome is complete and includes sufficient evidence.

7.5 points

A description of the outcome is extremely thorough with substantial evidence

Timeline

Timeline

0 points

A description of the timeline is not included.

6 points

A description of the timeline is incomplete or incorrect.

6.6 points

A description of the timeline is included but lacks evidence.

6.9 points

A description of the timelines is complete and includes sufficient evidence.

7.5 points

A description of the timeline is extremely thorough with substantial evidence.

PICOT

PICOT

0 points

The PICOT statement is omitted.

12 points

The PICOT statement is incomplete.

13.2 points

The PICOT statement is presented but there some inaccuracies.

13.8 points

The PICOT statement is presented. Some detail is needed.

15 points

The PICOT statement concisely and accurately describes the problem.

Problem Statement

Problem Statement

0 points

A problem statement is not included.

12 points

The problem statement is incomplete.

13.2 points

The problem statement is generally presented. There are some inaccuracies. More support is needed to justify or rationalize the problem.

13.8 points

The problem statement is presented. Adequate support is provided to justify or rationalize the problem.

15 points

The problem statement concisely describes the issue using strong support to rationalize and justify the problem.

Required Sources

Required Sources

0 points

Sources are not included.

3 points

Number of required sources is only partially met.

3.3 points

Number of required sources is met, but sources are outdated or inappropriate.

3.45 points

Number of required sources is met. Sources are current, but not all sources are appropriate for the assignment criteria and nursing content.

3.75 points

Number of required resources is met. Sources are current and appropriate for the assignment criteria and nursing content.

Mechanics of Writing

(Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.)

0 points

Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.

3 points

Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.

3.3 points

Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.

3.45 points

Few mechanical errors are present. Suitable language choice and sentence structure are used.

3.75 points

No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.

Format/Documentation

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.

0 points

Appropriate format is not used. No documentation of sources is provided.

3 points

Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.

3.3 points

Appropriate format and documentation are used, although there are some obvious errors.

3.45 points

Appropriate format and documentation are used with only minor errors.

3.75 points

No errors in formatting or documentation are present.