Assignment: Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Assignment: Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Advanced Levels of Clinical Inquiry
The promotion of evidence-based practice in nursing is important to ensure safety, quality and efficiency in patient care. Nurses utilize best practice interventions to ensure that care that optimizes the care outcomes of the patients is given. Nurses also engage in clinical inquiries to determine the ways in which traditional practices can be improved. Therefore, the purpose of this paper is to explore the issue of opioid abuse among pregnant mothers and develop a PICOT question that will guide the investigation.
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Identification and Description of the Clinical Issue
The selected practice issue is opioid use among pregnant mothers. Opioid use among women during pregnancy is a critical public health concern due to its effects on the mothers and their developing babies. According to statistics by the NIH, the number of pregnant women who used opioids quadrupled between 199 and 2014 (NIH, 2020b). Evidence from studies shows that about 400000 infants are exposed to illicit drugs or alcohol in utero every year in the USA. Opioid use and abuse during pregnancy increases the risk of seizures, migraine headaches, elevated blood pressure, and miscarriage (Patrick et al., 2017). The risk of stillbirths in this population is 2-3 times that of women that smoke tobacco or marijuana. Babies born to mothers who abused opioids during pregnancy have been shown to be highly at a risk of developing neonatal abstinence syndrome (NIH, 2020a). Due to the nature of its severity, evidence-based interventions are needed to reduce and prevent opioid abuse among pregnant mothers for their health and that of their babies.
Development of PICOT Question
The developed PICOT question that would guide the project is; in pregnant mothers who use and abuse opioids, does the use of psychosocial interventions reduce opioid use and abuse when compared to no use in a period of six months? The PICOT question was developed by following a number of steps. The first step entailed exploring the issues that are experienced in daily practice as a nurse. In specific, issues affecting pregnant were explored, leading to the identification of the issue of opioid abuse. The practice experiences of the nurse also informed the selection of the issue, as it is prevalent in their practice setting. The next step entailed exploration of the interventions used in managing opioid use and asking further areas of improvement that could be explored. Sources of evidence-based information were explored, leading to the identification of the practice intervention, which entails the use of psychosocial interventions. A PICOT question was then developed to guide the evidence-based project that would focus on the issue of opioid use and abuse in pregnancy among women.
Research Databases
The search for sources of evidence-based data was undertaken in four databases. They included EMBASE, Science Direct, EBSCO, and Cochrane Library.
Peer Reviewed Articles
The search yielded four articles that provided insights into the effectiveness of psychosocial interventions for opioid abuse in pregnancy. They include the studies by Brown, (2018), Hai et al., (2019), Rice et al., (2020) and Tran et al., (2021).
Levels of Evidence
The above selected studies are associated with varying levels of evidence. For example, the study by Brown, (2018) provides level II evidence, as it is a systematic review of a combination of quasi-experimental and randomized controlled studies and does not include meta-analysis. The study by Rice et al., (2020) provides level I evidence because it is a systematic review of randomized controlled trials with meta-analysis. The study by Tran et al., (2021) provides level III evidence, as it is a systematic review of a combination of quasi-experimental, randomized controlled trials and non-experimental studies without a meta-analysis. Lastly, the study by Hai et al., (2019) provides level I evidence, as it is a systematic review of randomized controlled trials with a meta-analysis.
Strengths of Using Systematic Reviews
Systematic reviews are effective for use in research because of the strengths associated with them. Firstly, systematic reviews provide highly reliable evidence about a topic. Since the evidence is obtained from multiple studies conducted on a topic, the risk of bias in the obtained results is significantly reduced, hence, reliability of findings. Systematic reviews also provide a comprehensive analysis of evidence related to a topic. The analysis yields evidence on the issues in the topic that should be explored to inform practice. As a result, systematic reviews act as sources of gaps in practice to be explored through nursing research. Unlike most of the quantitative studies, systematic reviews provide trustworthy evidence. The trustworthiness of the evidence is attributed to the transparency in the entire methods used in systematic reviews. The researcher therefore makes informed and unbiased decisions on the credibility of the findings due to the transparency in methods used (Moule, 2020). Based on the above, systematic reviews prove the most reliable sources of evidence when compared to other forms of researches.
Conclusion
Overall, opioid use and abuse among pregnant mothers is a critical public health issue with adverse implications to mothers and their unborn babies. Interventions that reduce and prevent use and abuse of opioids in this population are critical. Psychosocial interventions promise to alleviate the burden of the issue of opioid use and abuse among pregnant mothers. Therefore, it is anticipated that the implementation of the project will provide significant insights into the effectiveness of psychosocial interventions in addressing the problem.
References
Brown, A. R. (2018). A Systematic Review of Psychosocial Interventions in Treatment of Opioid Addiction. Journal of Social Work Practice in the Addictions, 18(3), 249–269. https://doi.org/10.1080/1533256X.2018.1485574
Hai, A. H., Franklin, C., Park, S., DiNitto, D. M., & Aurelio, N. (2019). The efficacy of spiritual/religious interventions for substance use problems: A systematic review and meta-analysis of randomized controlled trials. Drug and Alcohol Dependence, 202, 134–148. https://doi.org/10.1016/j.drugalcdep.2019.04.045
Moule, P. (2020). Making Sense of Research in Nursing, Health and Social Care. SAGE.
NIH. (2020a). Substance Use While Pregnant and Breastfeeding. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/substance-use-while-pregnant-breastfeeding
NIH. (2020b, January 22). Substance Use in Women DrugFacts. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/substance-use-in-women
Patrick, S. W., Schiff, D. M., & Prevention, C. on S. U. A. (2017). A Public Health Response to Opioid Use in Pregnancy. Pediatrics, 139(3). https://doi.org/10.1542/peds.2016-4070
Rice, D., Corace, K., Wolfe, D., Esmaeilisaraji, L., Michaud, A., Grima, A., Austin, B., Douma, R., Barbeau, P., Butler, C., Willows, M., Poulin, P. A., Sproule, B. A., Porath, A., Garber, G., Taha, S., Garner, G., Skidmore, B., Moher, D., … Hutton, B. (2020). Evaluating comparative effectiveness of psychosocial interventions adjunctive to opioid agonist therapy for opioid use disorder: A systematic review with network meta-analyses. PLOS ONE, 15(12), e0244401. https://doi.org/10.1371/journal.pone.0244401
Tran, M. T. N., Luong, Q. H., Le Minh, G., Dunne, M., & Baker, P. (2021). Psychosocial Interventions for Amphetamine Type Stimulant Use Disorder: An Overview of Systematic Reviews. Frontiers in Psychiatry, 12, Article number: 512076.
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Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
• Review the Resources and identify a clinical issue of interest (Mental health)that can form the basis of a clinical inquiry.
• Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
• Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question so select the most important concepts to search and find the best evidence available.
• Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.
The Assignment (Evidence-Based Project)
Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Write 2-3 page paper
• 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. (Mental health)
• 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 relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
• 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.