EVIDENCE-BASED CLINICAL QUESTION

EVIDENCE-BASED CLINICAL QUESTION

EVIDENCE-BASEDCLINICAL QUESTION

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Thispaper entails the analysis of evidence-based research findingsobtained from clinical question to bring about best nursing practice.Clinicians at most cases encounter challenges in their treatmentplan, in order to improve their treatment results clinicians explorefurther research to formally obtain the best nursing practiceexperiences (Hoffmann at al., 2010). The ability to record new way ofdischarging nursing practice and obtain new understanding both withinthe field of nursing and the general healthcare system is compelling.The most appropriate way of conducting this form of research by newclinical practitioners is through interaction with researchers withexperience in the field to obtain the best form of study. This formof interaction offers the opportunity for the new researchers toshape their research question, with their limited grasp on thesubject the experience research community gives them the appropriatesteps needed to proper formulate of PICOT question (Hoffmann at al.,2010). The scope of this paper covers the formulation of the PICOTquestion, how it is implemented using the evidence-based researchderived during the development of systemic review.

PICOTQuestion

ThePICOT format is a system utilized to develop questions when carryingout evidence based research practice. PICOT is an abbreviationstanding for population/ patient problem, intervention, Comparison,Outcome and Time as represented by the letters respectively. (P)Population/ patient problem represent the identified category ofsubjects the clinical researcher would like to recruit to make partof the study. In the sample of subjects selected, the researcher needto define the appropriate subjects who will most likely provide therequired respond concerning the specified intervention from thosesubjects mainly termed as generalized patients less likely tocontribute to the responses needed in the actual practice. In otherwords, this defines the patient in question, that is the form ofdisease they suffer from, their health status, race, sex, and age.(I) Intervention represent the form of treatment the samplepopulation enrolled for the study needs to be given. Interventionbasically entails what the clinical researcher is planning to do withthe sample patients, the specific therapies, medication and tests(Hoffmann at al., 2010).

(C)Comparison provides the clinicians alternative plan used as areference group which offers the comparison with treatmentintervention. Most researchers call this control group, which caneither be under no treatment, or undergoing a different form oftreatment. (O) Outcome is the expected results intended to be used tomeasure the effectiveness of intervention put in place. This is theoutcome the clinical researcher is seeking, which can range from nosymptoms, less symptoms or full health among others. (T) Time givesthe duration the research study would take for the completion ofcollection of data.

Therefined PICOT question for this evidence based research paperinvolves the population having a history of alcohol abuse (P). Theaim of the research attempts to find out whether Alcohol BriefInterventions (ABI) (I) would help prevent relapse or not (O) withina period of at least 12 successive months (T). The individuals undertreatment would then be compared with those individuals who adoptedto manage their addition with no treatment or under standardtreatment (C).

Reviewof the clinical Question

Alcoholabuse refers to the state at which an individual develops a patternof drinking that ultimately leads to a number of effects within aperiod of close to a year. The obvious effect of alcohol abuse bymost individuals addicted to alcohol is the failure to completeimportant school, home or work responsibilities. Experiencingrecurring alcohol-related legal problems, for instance driving underalcohol influence leading to an individual being arrested orphysically harming someone while drunk (Lankford, 2007). In addition,an individual continue abusing drugs despite existing relationshipproblems caused in the process. Dependence on alcohol represents theworst form of alcohol abuse. Alcohol abuse is a chronic disease whichis indicated by alcohol consumption at the level which results to thedisruption of mental and physical health and also the social andfamily responsibilities.

Individualswith the history of alcoholism are both determined by environmentaland genetic factors (Lankford, 2007). The sample populations inquestion for this research are those addicted to alcoholism withrecognizable symptoms and a course which is predictable.

Theform of intervention adopted is known as Alcohol Brief Interventions(ABI) (Jayasekara, 2011). This type of treatment involvespsychological treatment which targets to help the affected populationreduce and eventually cut down the abuse of alcohol and drugs. It isdone by conducting motivational interviewing where the counsellor orclinicians and the drug or alcohol abuser regularly meet within oneand four times for duration of one hour each meeting session. Thecounselor let the patient become aware of the fact that as thecounsellor he/she understands what they undergo through and feelconcerning their problem and that they are willing to assist thepatient make their own informed decisions (Jayasekara, 2011).

Asthe counselor, he/she does not make a great deal of effort toconvince the patients to change their behavior, but they discuss withthe patient the possible expected consequences of staying the same orchanging their behavior. At the end of the counselling process, thecounsellor discusses the patient’s goals and the level with whichthey are at that moment in relation to these expected goals.

Theresearch paper purely involves the search studies of populationhaving the history of drug or alcohol problems, which are dividedinto two groups, that is those individuals under the treatmentAlcohol Brief Interventions (ABI) and the other population calledcontrol group which received either other form of treatment or noparticular treatment.

Systemicreview and error analysis

Itis approximated that of the world’s population more than 76 millionpeople have alcohol related problems while around 15 millionexperience drug problems. It poses as a global problem, which affectsa significant number of people in the world. The study gives adetailed account of findings obtained by evaluating the efficiency ofbrief alcohol interventions (BAI) for population of male adults 16years and above.

Theresearch studies focuses on the alcoholic population where theclinician offers BAI as the choice form of medication and test itseligibility as the best intervention plan of alcoholic patients(Jayasekara, 2011).To indicate how this form of treatment works, thechancellor selected another set of population whose treatment wasdifferent or were allowed to recover on their own. The expectedoutcome for this treatment is no relapse or suppressed alcohol intakewithin a period of a year. But in the process of this research,errors might be encountered in that the patients might not respond tojust highlighted consequences without being given proper alternativeto adopt as the gradual recovery process.

Evidence-basedcontrol Trial

Thealternative treatment for Brief Alcohol Intervention which acted ascontrol trial was the managed alcohol programmes (MAPs) (Muckle atal., 2012). It is the strategy employed to treat patients addicted toalcohol through administering regulated intake of alcohol on a dailybasis, with an ultimate objective of ensuring the patients take safealcoholic drinks CITE. This programmes is done in an environment setup known to sustain patients undergoing such treatment, reducingtheir consumption of alcohol and improving the patients socialfunctioning- this is reduced regular medical care, criminal activityand raising the quality of life (Muckle at al., 2012). This programmehighlights an intervention that targets to change the patient’spattern of drinking and consequently decrease the associated effectsof alcohol behaviors.

MAPhelp reduce personal harm and any other associated adverse societaleffects of alcohol. Thisis achieved through the adoption of atreatment plan which does not advocate for zero-tolerance approachbut adopting regulated drinking goals that augur well with theindividual needs and in turn promotes access to services by providinglow-threshold alternatives (Muckle at al., 2012). This form oftreatment enables the patients gain access to services despite theircontinued consumption of alcohol and also it will assist the patientsunderstand the associated risks in their behavior and thus helps themmake informed decisions concerning their own treatment objectives.

TheMAP main objective was to access the effectiveness of this treatmentregimes, through offering the selected patients regulated amounts ofalcohol everyday on their own when compared to self-controlleddrinking or moderate drinking. It is the best alternative to the useof other interventions methods such as the usual abstinence approach,BAI, and no intervention.

Theselection criteria employed for the control trial involved the use ofregulated clinical trials conducted in the vulnerable population of18 years and above having a greater risk of alcohol abuse and wererequired to attend to MAP (Muckle at al., 2012). This brought about awell-structured programme that offered the patients with theregulated intake of alcohol on a daily basis.

Allthe citations of this research study were sourced from a singledatabase. In the review of the paper, two independent authorsconducted a thorough screening of the research abstracts, titles andall the chosen references having the required relevance in thereview. Any arising variations between the categories selected wereaddressed through extensive discussion. The two authors conductingthe review worked independently to examine whether certain studiesought to be included or excluded based on the eligibility criteria.When any form of disagreement arose the third author was called onboard.

Fewstudies were included in the review process. The orderly reviewconducted was required to examine the effectiveness of MAP to manageincidences of harmful behavior, on the contrary there were lack ofevidence to make this comparison (Muckle at al., 2012). About 22articles were examined with the researchers perceiving them relevantto the study, but after a deep scrutiny the materials were excluded.Many of the articles were not considered for this study because itnever attained the required comparison standard which in other wordsdid not regard alcohol management as experimental or as controlintervention (Muckle at al., 2012).

Inother articles, the researchers failed to include the materialssolely because the participants were below the age of 18 years. Ofall the studies reviewed, almost all of them provided no interventionthat could be compared with the alcohol management or offered therequired intervention of interest therefore, this did not providethe sufficient evidence needed to resolve the review objectives. Infour studies (Muckle at al., 2012), its main concern of alcoholreduction provided a similar subject like the control trial research,all targeting alcohol reduction as the ultimate outcome of interest.One study however (Muckle at al., 2012), provided an assessment thatwas qualitative to the participants enrolled to the MAP, but on theother hand, it did not provided analysis of the programme itself. Allthe results provided in this research indicated accurately that theMAPs as a treatment alternative is useful in the current practicewith few samples pilot projects adopts the programme targeting thepatients having a severe history of alcohol dependence (Muckle atal., 2012)

Casestudy summary

Thecase study selected targets the population having a history ofalcohol abuse. Clinical researchers undertaking the study uses theBrief Alcohol Intervention (BAI) as the choice form of treatment tothe patients. The expected outcome of this study is to help peoplestop or reduce intake of alcohol. To ascertain the effectiveness ofthis treatment plan, the counsellors categorize the affected patientsinto two such that the other group is given an alternative form oftreatment. The alternative or control trial helps indicate the degreewith which the selected form of treatment wields in the behavior ofthe affected individuals (Lippincott, 2015).

Acounsellor undertaking the treatment meets with the patients betweenone and four times for an hour in each counselling session. Unlikethe other alternative form of treatment (MAPs), where the patientsalcohol intake is regulated which eventually leads to the reduction,brief alcohol intervention do not focus on rehabilitation practicesbut it is solely involved with highlighting to the sample patients the adverse effects associated with alcohol and drugs abuse for ashort or brief period of time. This form of treatment, therefore,gives the patients independence to make their own informed decisionusing the provided awareness. Upon cooperating with the counsellor’ssuggestion, the counsellor will support the patient in the recoveryprocess. The professional relationship with the patient, where thecounsellor shows that he/she has a good grasp of the problem makesthe patient cooperate and become willing to relinquish alcohol abuse.

Studyapproach, sample size and the population under study

Thisresearch study was based mainly in the healthcare setting where thepatients undergoing treatment made up a clinical sample. The approachused to provide treatment to the sample population was counsellingtherapy. The health care professionals make an effort to interrogatethe affected patients their drinking patterns and thus provide briefinterventions. The type of intervention adopted is brief with thetarget to change the behavior of affected population. Having ahistory of addiction to alcohol abuse, the patients are offeredcounsel of the expected outcome and effects of drug and alcoholabuse. The counsellor met with the sample population for about one tothree times with the patients for an hour each session.

Duringthe sessions the counsellor or the health professional involvesmotivational interviewing also highly skilled based counselling maybe used which requires feedback and discussion on self-efficacy andresponsibility. This happens in hospitals where the affectedindividual is admitted as an inpatient and taken to general medicalwards or in some instances trauma centers where the heavy alcoholusers get the opportunity for intervention, and in the process madeaware the possible links between their hospitalization and alcoholabuse (Lippincott, 2015).

Thesample populations under study are the heavy alcohol users who may behospitalized for alcohol related problems. This problems range fromeffects such as injuries, accidents, psychiatric and physicalillnesses, sicknesses that are frequent, social problems and jobabsenteeism brought about by heavy patterns of alcohol consumption(Lippincott, 2015). The authors conducting the review used 14randomized controlled trials and controlled clinical trials involving4041 male adults 16 years and above diagnosed to heavy alcohol anddrugs abusers in the hospitals mainly in the USA and UK.

Evidenceapplication

Fromthe evidence derived from this study, there is a clear indicationthat the population having a history of alcohol abuse experiencedalcohol related problems. As shown by several cases of affectedindividuals admitted to hospitals for treatments, above 4000 cases ofmale trials recorded for this study, there is need for suchintervention intensified for more of alcohol addicts access thistreatments and general sensitization of its adverse effects(Jayasekara, 2011). Due to the promising results for this practice toheavy alcohol users in general hospitals, supports that furtherresearch by health professionals gives them an upper hand to dealwith cases before attaining hospitalization stage.

Theoutcome of the study

Themain results for this research study involving 4041 participantsmainly males showed there brief intervention plans is beneficial.From the results, the patients under treatment plan showed anincreased reduction of alcohol intake when compared with those underthe alternative treatment plan at six months of study. Severalreports showing the significant alcohol reduction by one year infavor of brief intervention were recorded. What is more was the factthat there were fewer deaths resulting from brief intervention whencompared with the other alternatives. It therefore, makes thisresearch study valid and appropriate to screen and make a positiveimpact in the lives of the participants decreasing alcohol intake andchanging drinking behavior (Jayasekara, 2011).

Biasin the study

Fromthus evidence-based research study there was deliberate bias in thesample population. The scope of the research study only focused onthe male population with the female population excluded in theresearch, this in effect aligned to only one gender and consequentlycontributed to lack of gender balance (Jayasekara, 2011). In additionto gender bias, the research study was also biased in terms of age.The male population in the research study was only those who hasattained the age of 16 years and above

Thelevel of evidence identified

Thelevel of evidence identified in the study review was of high qualityand meet the expected standard. First the sample population involvedwas mature adolescents and adults, 16 years and above (Jayasekara,2011). These groups of patients are mature enough to understand thecounselling and treatment plans. Secondly, the patients undergoingthis treatment were diagnosed to be only those experiencing alcoholrelated problems and were specifically admitted to the generalinpatient hospital care which ensured they received brief alcoholintervention. In order to provide quality data, three reviews workindependently to ascertain the reliability of the extracted and theselected studies (Jayasekara, 2011). In the analysis of the results,random effects meta- analysis and sensitivity analysis wereconducted.

References

Hoffmann,T., Bennett, S., &amp Del, M. C. (2010). Evidence based practiceacross the health professions. Sydney: ChurchillLivingstone/Elsevier.

Jayasekara,R., (2011). Brief interventions for heavy alcohol users admitted togeneral hospital wards. Wiley-Blackwell.

Lankford,R. D. (2007). Alcohol abuse. Detroit: Greenhaven Press.

Lippincott.W., (2015). Pathophysiology + Lippincott Nursing Drug Guide +Lippincott Manual of Nursing Practice, 10th Ed. + Leadership Rolesand Management Functions in Nursing, 8th Ed. + Evidence-BasedPractice in Nursing &amp Healthcare, 3rd Ed.

Muckle,W., Muckle, J., Welch, V., &amp Tugwell, P. (2012). Managed alcoholas a harm reduction intervention for alcohol addiction in populationsat high risk for substance abuse. The Cochrane Database of SystematicReviews, 12.