NURS 6052 Essentials of Evidence-Based Practice

NURS 6052 Essentials of Evidence-Based Practice

NURS 6052 Essentials of Evidence-Based Practice

Opiate Use/Abuse in Adolescents

Adolescent opioid users

For many years, opioids have been the number one choice for the treatment of chronic pain. Doctors are prescribing different types of opioids ranging from mild to intense to their patients as pain relievers. However, using opioids has become a significant public health concern stemming from its overuse by patients.

It is estimated that up to 20 million Americans by 2015 qualified to be under opioid medication due to acute or chronic pain they were experiencing (Brook, & Rajagopalan, 2018. NURS 6052 Essentials of Evidence-Based Practice). The number has since multiplied due to the increase in the number of people seeking treatment for chronic pain, which has a positive correlation with the number of people with Opioid Use Disorder (OUD). This research will also look at the methods available for treating opioid addiction, such as using Buprenorphine-Naloxone and alternatives such as methadone.

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The use of opiate abuse among adolescents has become a big concern in public health due to the rising cases of misuse of the drug. Just like there is an increase in the number of young people using opioids, there is also a corresponding increase in opiate overdose. According to a number of research, routine use of opiate use among adolescents account for 90% of overdose deaths in America (pp.1).

This means that up to 29% of adolescents on opioids misuse the drugs while another 12% of youths on opioids have OUD-Opioid Use Disorder Center for Disease Control and Prevention. (2021 NURS 6052 Essentials of Evidence-Based Practice). Reducing cases of opiate misuse and overdose among the youths require better approaches that are non-addictive, effective, and safe.

The use of opiates among adolescents continue to plague millions of youths in America.  According to American government, the balance between pain management using opioids and its misuse is already a thin line. This leads to many questions regarding the suitability of opioids in the management of chronic pain. However, the research question chosen for this research is: Is there a safer, effective, and nonaddictive way of treating patients with Opioid Use Disorder?

As of 2015, up to 20 million Americans were thought to be candidates for substance use disorder, particularly, opioids. Furthermore, misuse of opioids cost America losses of $504 billion in 2017 (Quirtet al., 2018). The research question will be helpful in analyzing if it is prudent to continue using opioids for pain management or whether to adopt other safer and effective methods. NURS 6052 Essentials of Evidence-Based Practice

Pharmacotherapies And Behavioral Interventions

The chosen course of action is a treatment for the patient. This is because the patient not only suffers from chronic pain but is also addicted to opioids. As mentioned before, the misuse of opioids accounts for over 70% of fatal cases of overdose (Centers for Disease Control and Prevention, 2019). The question, therefore, is about treating patients who are already addicted to the drug and making them clean. One way that can be used to treat patients with OUD and to reduce their dependence on opioids is by using Buprenorphine-Naloxone treatment. This treatment will help the patient to reduce his dependence on opioids.

Buprenorphine-Naloxone treatment is a relatively new medicine that still has to be researched fully. The medication has some side effects such as difficulty in breathing, addiction, and death in case of overdose-which is rare due to its high tolerant ceiling effect. The other alternative that can be used on patients with opioid use disorder is methadone-another effective drug for dealing with opioid addiction.

Methadone has two distinct qualities which makes it the best replacement for Buprenorphine-Naloxone (Quirtet al, 2018 NURS 6052 Essentials of Evidence-Based Practice). One, it works as a pain reliever and two, it does not create the high that people get when using other drugs. Additionally, methadone can help in eliminating withdrawal symptoms, making it a good treatment for opioid addiction.

Using Buprenorphine-Naloxone is associated with positive outcomes because the drug reduces cravings for opioids as well as lessening the impact of withdrawal symptoms. Being a partial agonist derived from opioids, Buprenorphine-Naloxone is much safer than most full agonist drugs used in the treatment of opioid addiction.

Even at higher doses, the effect of the drug is still quite mild which makes it difficult to abuse. The side-effects of Buprenorphine-Naloxone are also mild and usually include; anxiety, drowsiness, headache, and nausea. The ceiling effect of Buprenorphine also adds to its safety in case of overdose. This characteristic of the drug makes it have a low morbidity rate. NURS 6052 Essentials of Evidence-Based Practice

American Community Health Survey that revealed that close to 10% of Americans suffer from some form of opiate abuse. The study was conducted among young and old Americans to find out the prevalence of the disease in these demographic groups. The epidemiological evidence from the study showed that young people below 19 years and old people above 60 years are the most affected by this respiratory problem.

Studies conducted in America to evaluate the number of deaths caused by opiate abuse annually show grim picture of the situation. Up to 10% of the American population is affected by Opiate abuse (Koppikar, et al, 2021). A recent cohort study done in Ontario revealed that the prevalence of Opiate abuse has increased to 55% from a low of 8.5% in 2003 (Koppikar, et al, 2021 NURS 6052 Essentials of Evidence-Based Practice).

Opiate abuse is a respiratory problem that affects the airways causing difficulty in breathing. T helper cells are associated with Opiate abuse and affect immune responses. There are many triggers for Opiate abuse such as dust, dander from animals, cockroach residue, pollen from plants, and cold air in some people.

The major question that the government grapples with in opiate use in adolescents is “do the prenatal risk factors increase the chance of Opiate abuse in young people”? To answer this question, the research identifies up to 5 clinical Opiate abuse phenotypes that differ distinctly from a lung infection. There is the non-atopic phenotype that represents the groups of children that experience wheezing episodes.

In a research study, a population is defined as a set of elements (People or objects) that have similar characteristics as quantified by a researcher. On the other hand, the word sample in research refers to selected objects or elements chosen to participate in a study. This study sought to capture the experiences of older men and young children working in Ontario America. NURS 6052 Essentials of Evidence-Based Practice

According to the American College of Cardiology-ACC and American Heart Association-AHA., the best methods for determining the impact of Evidence-based practice Clinical guidelines is through scientific measurement of patient outcomes. The authors assert that the implementation of EBPCG can only work when it is practiced by nurses and patients (Wheton et al., 2017 NURS 6052 Essentials of Evidence-Based Practice).

The impact factor, in this case, is measured based on the number of citations present in the research or paper. In this work, such metrics provide a reliable and effective method of measuring the impact that clinical guidelines have on scientific research on evidence-based practice. However, the AHA and ACC point out that the growth of analytical tools used in harvesting information from online databases has helped the research on Evidence-based practice Clinical guidelines to take a multi-disciplinary approach such as sociological approach, scientific approach, structural approach, and technological approach (Whelton et al., 2017 NURS 6052 Essentials of Evidence-Based Practice).

The two institutions continue to assert that “most importantly, discoveries in the basic science of AD would be entirely impotent without close collaborations with investigators in translational, clinical, and public health disciplines,” (American College of Cardiology-ACC and American Heart Association, 2017). This statement is conclusive and takes into consideration the work of individual researchers as critical additions to research on EVPCG.

Influence The Prevalence of Opioid Abuse and Misuse

The use/misuse of opioids among young people elicits mixed reactions among millions of people who oppose its continued use. One of the most advanced theories that have been used to explain as well as provide an effective framework for the treatment of opioid addiction is the Brain Theory of Social Attachment-BOTSA. This theory provides that managing physical and emotional pain in opioid addicts can be effectively managed by managing social connections, and subjective experiences of opioid addicts.

According to Inagaki (2018), BOTSA theory holds that strong social connections or attachments can lead to reduced opioid activity (p. 2). This means that patients or people under opioid treatment should be encouraged to be always in the presence of friends or loved ones rather than live in separation. Staying in isolation increases the urge in addicts to use more opioids as a way of responding to social stressors. Thus, Brain Theory of Social Attachment asserts that social connection is related to wellbeing. NURS 6052 Essentials of Evidence-Based Practice

The Brain Theory of Social Attachment provides a clear framework for the treatment of opioid addiction. In this case, the issue of stopping opioid addiction is dependent on the allegiances or strong bonds formed by addicts (Inagaki, 2017, p. 4). However, this process would require an effective grieving and or mourning process such as losing a loved one.

The social connection process is considered therapeutic and can help in the healing process of opioid addicts. However, according to Reboussin et al., (2018 NURS 6052 Essentials of Evidence-Based Practice), this theory works on the assumption that for every addict, there will be a sufficient grieving process that many never occur (p. 149). On the other hand, even without the grieving process, the strong connections and bonds formed by addicts and their loved ones may be sufficient to control their opioid intake.

Managing patients with acute or chronic pain poses significant challenges in nursing. This is further compounded by the fact that over half of all patients under opioid medication are addicted to the drug (Volkow, & McLellan, 2017). In 2017, the US government declared opioid addiction a national emergency. Further research revealed that 20 in 100,000 people died from an opiate misuse (Quirt et al., 2017 NURS 6052 Essentials of Evidence-Based Practice).

The significance of the problem is that using opioids in pain management has created hundreds of thousands of opioid-dependent people and a significant number of people who die from an overdose. To date, using opioids remains the best way to treat chronic pain. According to research, opioids can reduce chronic pain by up to 30%, which makes the best chronic pain reliever available (Quirt et al., 2017). However, the primary issue is the thin balance between managing pain using opioids and opioid addiction. The implication has been the increase in apprehension concerning the use of opioids in the treatment of enduring agony.

Conclusion

Dependency on opioids has resulted in a far much bigger problem in which millions of people have become addicted to the drug, while many more die due to overdose. The objective of this paper is to determine approaches to eliminate or lessen the addiction to opioids in patients suffering from Opioid Use Disorder. Opioids have been critical in pain relief, but some individuals have been misusing them to the point that questioning their usability has become imperative. The balance between pain management using opioids and its misuse is already a thin line.

This research will, therefore, work on the hypothesis that there are better alternatives to treating OUD for the millions of patients who are addicted to opioids. The theory thus states:  Buprenorphine-Naloxone can be used effectively to treat opioid addiction. Buprenorphine-Naloxone treatment has the capability to cut off the patient’s addiction to opioids . In this case, the success of managing the opioids epidemic in America depends on the success of the treatment method chosen. NURS 6052 Essentials of Evidence-Based Practice

NURS 6052 Essentials of Evidence-Based Practice References

Brook, R., & Rajagopalan, S. (2018). ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of Opiate abuse in Adults. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal Of The American Society Of Hypertension, 12(3), 238. doi: 10.1016/j.jash.2018.01.004

Center for Disease Control and Prevention. (2021). Understanding the Epidemic | Drug Overdose | CDC Injury Center. Retrieved 24 June 2021, from https://www.cdc.gov/drugoverdose/epidemic/index.html

Inagaki, T. (2017). Opioids and Social Connection, The journal of psychological sciences, 1–18. doi: 10.31234/osf.io/27cnv

Reboussin, D., Allen, N., Griswold, M., Guallar, E., Hong, Y., & Lackland, D. et al. (2018). Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of Opiate abuse in Adults. Journal Of The American College Of Cardiology, 71(19), 2176-2198. doi: 10.1016/j.jacc.2017.11.004. NURS 6052 Essentials of Evidence-Based Practice

Quirt, J., Hildebrand, K., Mazza, J., Noya, F., & Kim, H. (2018). Opiate abuse. Allergy, Opiate abuse& Clinical Immunology, 14(S2). doi: 10.1186/s13223-018-0279-0. NURS 6052 Essentials of Evidence-Based Practice

Volkow, N. D., & McLellan, A. T. (2017). Opioid abuse in chronic pain—misconceptions and mitigation strategies. New England Journal of Medicine, 374(13), 1253-1263.

Inagaki, T. (2017). Opioids and Social Connection, The journal of psychological sciences, 1–18. doi: 10.31234/osf.io/27cnv

Whelton, P., Carey, R., &Aronow, W. (2018). ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of Opiate abuse in Adults: A Report of the American College of Cardiology/American Heart Association. Task Force on Clinical Practice. KIDNEYS, 7(1), 68-74. https://doi.org/10.1161/HYP.0000000000000065

NURS 6052/ NURS5052/ NRSE6052 Essent of Evidence

Week 1 Assignment – Evidence-Based Practice and the Quadruple Aim

NURS 6052 Essentials of Evidence-Based Practice

Healthcare organizations continually seek to optimize healthcare performance. For years, this approach was a three-pronged one known as the Triple Aim, with efforts focused on improved population health, enhanced patient experience, and lower healthcare costs.

More recently, this approach has evolved to a Quadruple Aim by including a focus on improving the work life of healthcare providers. Each of these measures are impacted by decisions made at the organizational level, and organizations have increasingly turned to EBP to inform and justify these decisions.

To Prepare:

Read the articles by Sikka, Morath, & Leape (2015); Crabtree, Brennan, Davis, & Coyle (2016); and Kim et al. (2016) provided in the Resources.

Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.

Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery. NURS 6052 Essentials of Evidence-Based Practice

To Complete:

Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim.

Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of:

Patient experience

Population health

Costs

Work life of healthcare providers

NURS 6052 Essentials of Evidence-Based Practice Week 2 & 3 Assignment

Evidence-Based Project

Is there a difference between “common practice” and “best practice”?

When you first went to work for your current organization, experienced colleagues may have shared with you details about processes and procedures. Perhaps you even attended an orientation session to brief you on these matters. As a “rookie,” you likely kept the nature of your questions to those with answers that would best help you perform your new role.

Over time and with experience, perhaps you recognized aspects of these processes and procedures that you wanted to question further. This is the realm of clinical inquiry.

Clinical inquiry is the practice of asking questions about clinical practice. To continuously improve patient care, all nurses should consistently use clinical inquiry to question why they are doing something the way they are doing it. Do they know why it is done this way, or is it just because we have always done it this way? Is it a common practice or a best practice?

In this Assignment, you will identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed. NURS 6052 Essentials of Evidence-Based Practice

To Prepare:

Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.

Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest.

Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.

Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.

Part 1: An Introduction to Clinical Inquiry

Create a 4- to 5-slide PowerPoint presentation in which you do the following:

Identify and briefly describe your chosen clinical issue of interest.

Describe how you used keywords to search on your chosen clinical issue of interest.

Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.

Provide APA citations of the four peer-reviewed articles you selected.

Part 2: Identifying Research Methodologies

After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:

The full citation of each peer-reviewed article in APA format.

A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest. NURS 6052 Essentials of Evidence-Based Practice

A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.

A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.

A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.

NURS 6052 Essentials of Evidence-Based Practice Week 5 Assignment

Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?

In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected. NURS 6052 Essentials of Evidence-Based Practice

To Prepare:

Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.

Develop a PICO(T) question to address the clinical issue of interest for the Assignment.

Use the key words from the PICO(T) question you developed and search at least four different databases in the Library to identify at least four relevant peer-reviewed articles at the systematic-reviews level related to your research question.

Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

Identify and briefly describe your chosen clinical issue of interest.

Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.

Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected. NURS 6052 Essentials of Evidence-Based Practice

Provide APA citations of the four peer-reviewed articles you selected.

Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

NURS 6052 Essentials of Evidence-Based Practice Week 7 Assignment

Evidence-Based Project, Part 4: Critical Appraisal of Research

Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.

Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.

In this Assignment, you will use appraisal tools to conduct a critical appraisal of published research. You will then present the results of your efforts. NURS 6052 Essentials of Evidence-Based Practice

To Prepare:

Review the Resources and consider the importance of critically appraising research evidence.

Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.

Review and download the Critical Appraisal Tools document provided in the Resources.

The Assignment (Evidence-Based Project)

Part 4A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Critical Appraisal Tools document. Be sure to include:

An evaluation table

A levels of evidence table

An outcomes synthesis table

Part 4B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

Week 9 Assignment

Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes. NURS 6052 Essentials of Evidence-Based Practice

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

Reflect on the four peer-reviewed articles you critically appraised in Module 4.

Reflect on your current healthcare organization and think about potential opportunities for evidence-based change.

The Assignment: (Evidence-Based Project)

Part 5: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide PowerPoint presentation in which you do the following:

Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)

Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.

Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.

Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation. NURS 6052 Essentials of Evidence-Based Practice

Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.

Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.

Add a lessons learned section that includes the following:

A summary of the critical appraisal of the peer-reviewed articles you previously submitted

An explanation about what you learned from completing the evaluation table (1 slide)

An explanation about what you learned from completing the levels of evidence table (1 slide)

An explanation about what you learned from completing the outcomes synthesis table (1 slide)

NURS 6052/NURS5052/NRSE6052 Essent of Evidence Week 11 Assignment

Evidence-Based Capstone Project, Part 6: Disseminating Results

The dissemination of EBP results serves multiple important roles. Sharing results makes the case for your decisions. It also adds to the body of knowledge, which creates opportunities for future practitioners. By presenting results, you also become an advocate for EBP, creating a culture within your organization or beyond that informs, educates, and promotes the effective use of EBP. NURS 6052 Essentials of Evidence-Based Practice

To Prepare:

Review the final PowerPoint presentation you submitted in Module 5, and make any necessary changes based on the feedback you have received and on lessons you have learned throughout the course.

Consider the best method of disseminating the results of your presentation to an audience.

To Complete:

Create a 5-minute, 5- to 6-slide narrated PowerPoint presentation of your Evidence-Based Project.

Be sure to incorporate any feedback or changes from your presentation submission in Module 5.

Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy. NURS 6052 Essentials of Evidence-Based Practice