Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes

Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes

Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes

Throughout this course you have focused on practice problems to address in applying nursing and interdisciplinary theories, and in the application of evidence-based practice for quality improvement. This week you begin exploring the components of evidence-based practice by framing a practice problem as a critical question. You will begin a search of the literature for evidence to answer the question and inform a practice change for quality improvement.

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To prepare:

• Identify the practice problem as the focus of your Discussion post. You may use the same practice problem from earlier weeks or a different one.
• Review the chapter on practice questions in the Dang and Dearholt text and the Week 7 Media. With guidance from the Learning Resources, cast your practice problem as a critical question.
• Search the Walden Library for 2–3 scholarly articles that address your critical question.
• Analyze the articles to identify evidence that would guide quality improvement.
• Return to the stakeholders that were the audience for your Module 3 Assignment. Identify the specific quality improvement component in the evidence. Then consider how you would present it to that set of stakeholders to secure agreement and action.

With these thoughts in mind …

By Day 3 of Week 7

Post a brief explanation of your critical question. Then, summarize the 2–3 articles you identified that address your critical question. Using the same language you would use with stakeholders, explain the critical question and the value of addressing it as a quality improvement initiative. Be specific. Cite the scholarly articles and other resources to support your post.

Read a selection of your colleagues’ posts.

By Day 6 of Week 7

Respond to at least two of your colleagues on 2 different days by suggesting a different way of framing their critical question. Cite sources to support your posts and recommend to colleagues.

In middle age adult patients with opioid addiction, how effective is weekly patient contact and comprehensive education, compared to the standardized discharge plan 2 – 4 weeks follow-up, lowering readmissions rates for relapse within 30 days of hospital discharge?

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Framing a Practice Problem as a Critical Question with Measurable Outcomes

The critical question for this course is: In middle age adult patients with opioid addiction, how effective are weekly patient contact and comprehensive education, compared to the standardized discharge plan 2 – 4 weeks follow-up, in lowering readmissions rates for relapse within 30 days of hospital discharge? Opiate abuse and addiction have become an epidemic with a major impact on the health and wellbeing of individuals and societies globally. The US is one of the largest consumers of opiates worldwide, and it is estimated that about 2.1 million U.S. residents abuse opiates. Opioid addiction has one of the highest rates of relapse due to the rapid rate at which opioid tolerance builds compared with other drug substances (Sureshkumar et al., 2021). It is projected that roughly 91% of individuals recovering from opiate abuse will experience a relapse.

Various approaches are being used to lower the rates of relapse for individuals on opiate recovery. They include pharmacotherapy, behavioral counseling, cognitive-behavioral therapy (CBT), and long-term follow-up (Sureshkumar et al., 2021). The question seeks to establish if weekly patient contact and comprehensive education are more effective than the standardized discharge plan in reducing relapse among patients discharged after treatment for opiate addiction.

 McKay (2021) examined the literature on continuing care for alcohol and drug use disorders, including literature that discussed efficacy, mechanisms of action, moderators, and economic impact. The article explains that continuing care is extensively believed to be a vital component of effective treatment for substance use disorder (SUD), especially for patients with greater problem severity. The study findings established that continuing care of longer duration that involves more active efforts to keep individuals in recovery engaged can contribute to more consistent positive results. Besides, the study established that patients at higher risk for relapse, like those with a history of opiate addiction, may benefit more from continuing care (McKay, 2021). Approaches used include automated mobile health interventions to enhance more conventional counselor-delivered strategies and extended treatment and monitoring programs. Thus, the article supports my question that weekly patient contact can reduce readmission rates due to relapse in patients with opioid addiction.  

Sancho et al. (2018) systematically reviewed the efficacy of mindfulness-based interventions (MBIs) in substance and behavioral addictions (BAs). The study was informed by the increasing attention on interventions to educate patients with addictive behaviors on emotion  regulation and the interventions for improving these challenges, which helps prevent relapse and promote effective recovery. MBIs are used in various addictions, including substance use disorders like opiate and alcohol and BAs like gambling. The study found that educating patients on MBIs effectively alleviated dependence, craving, and other addiction-related symptoms. It also improved patients’ mood states and emotion dysregulation. The most widely used MBI strategies included Mindfulness Training for Smokers, Mindfulness-Based Relapse Prevention, and Mindfulness-Oriented Recovery Enhancement (Sancho et al., 2018). Therefore, comprehensive patient education that includes training on mindfulness interventions can be effective in preventing relapse among patients with opiate addiction.

Despite a wide range of pharmacological and psychosocial interventions for treating opioid dependence, the high prevalence of relapse within the first year, especially in the first three months of abstinence, deter the recovery of patients. Interaction between biological changes and psychosocial factors increases the vulnerability for relapse (Sureshkumar et al., 2021). Individuals who experience relapse face stigma, which worsens their already worse mental health state. Thus, it is crucial to address the high prevalence of opiate relapse to improve patients’ mental health and wellbeing, reduce healthcare costs for treating the disorder, and lower the social stigma associated with relapse.  

References

McKay, J. R. (2021). Impact of Continuing Care on Recovery From Substance Use Disorder. Alcohol Research: Current Reviews, 41(1), 01. https://doi.org/10.35946/arcr.v41.1.01

Sancho, M., De Gracia, M., Rodriguez, R. C., Mallorquí-Bagué, N., Sánchez-González, J., Trujols, J., … & Menchón, J. M. (2018). Mindfulness-based interventions for the treatment of substance and behavioral addictions: a systematic review. Frontiers in Psychiatry, 9, 95. https://doi.org/10.3389/fpsyt.2018.00095

Sureshkumar, K., Dalal, P. K., Kailash, S. Z., & Rudhran, V. (2021). Relapse in opioid dependence: Role of psychosocial factors. Indian Journal of Psychiatry, 63(4), 372. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_383_20