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Research Critiques and PICOT Statement Final Draft 

**THESIS STATEMENT AND CONCLUSION NEEDED**

Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback provided (I have this) from the previous course assignments and the guidelines below.

PICOT Question 

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

The final PICOT question will provide a framework for your capstone project. 

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions. **(I HAVE ATTACHED THOSE CRITIQUES TO USE FOR THIS ASSIGNMENT).** 

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question. **(MENTAL HEALTH NURSING, SUBSTANCE ABUSE, READMISSION RATES ETC)**

Refer to “Research Critiques and PICOT Guidelines – Final Draft.” 

Questions under each heading should be addressed as a narrative in the structure of a formal paper. **(I HAVE ATTACHED THE FINAL DRAFT TEMPLATE AND GUIDE TO USE FOR THIS ASSIGNMENT)**

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

Research Critique Guidelines – Part I

Use this document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the studies in your responses.

Qualitative Studies

Background of Study

1. Summary of studies. Include problem, significance to nursing, purpose, objective, and research question.

How do these two articles support the nurse practice issue you chose?

1. Discuss how these two articles will be used to answer your PICOT question.

2. Describe how the interventions and comparison groups in the articles compare to those identified in your PICOT question.

Method of Study:

1. State the methods of the two articles you are comparing and describe how they are different.

2. Consider the methods you identified in your chosen articles and state one benefit and one limitation of each method.

Results of Study

1. Summarize the key findings of each study in one or two comprehensive paragraphs.

2. What are the implications of the two studies in nursing practice?

Ethical Considerations

1. Discuss two ethical consideration in conducting research.

2. Describe how the researchers in the two articles you choose took these ethical considerations into account while performing their research.

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RUNNING HEADER: QUALITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATIONS 1

QUALITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATIONS 7

Qualitative Research Critique and Ethical Considerations

Angelique Christoffel

Grand Canyon University

Nurs 433V

June Helbig

August 23, 2020

Qualitative Research Critique and Ethical Considerations

The following critical appraisal of two studies is based on the PICOT question; In mental health patients with substance use disorders, does treatment, compared to non-treatment, reduce readmissions within 90 days? The articles chosen for the appraisal are “Qualitative study of perspectives concerning recent rehospitalizations among a high-risk cohort of veteran patients in Connecticut, USA” by Antony, Grau, and Brienza, and “Contribution of Psychiatric Illness and Substance Use to 30-Day Readmission Risk” by Burke, Donzé, and Schnipper.

Background of Study

In the article by Antony et al., the authors note that hospital readmissions have been a rising problem that has now become a national issue. It is said that readmissions are related to increased cost, and the relationship between quality of care and readmissions has been vague. Besides, the costs that readmissions incur, readmissions cause more complications for patients such as chronic comorbidities and increase impaired functional status, which makes increases their risk of death (Antony et al., 2018). Moreover, there have been system-level factors that have been associated with increased negative patient outcomes of death and rehospitalization. The study focuses on veteran affairs. These patients are at a higher risk of rehospitalization due to their older age, poor or lack of social support, low socioeconomic status, and pre-existing comorbidities (Antony et al., 2018). The study’s objective was to explore patients’ perceptions about the factors that contribute to rehospitalization and recommendations that minimize this risk.

In the article by Burke et al., the authors also note that readmissions are costly, especially among psychiatric patients. The study seeks to investigate the influence of psychiatric illness to readmission risk. According to the study, a psychiatric sickness may contribute to readmissions within the first 30 days, which is related to increased resource utilization (Burke et al., 2013). In New York hospitals, for example, mental illness patients discharged from the hospitals were more likely to be readmitted than their counterparts without mental illnesses. This resulted in an increased length of stay by approximately a day on average (Burke et al., 2013). The study’s objective was to evaluate the independent contribution of psychiatric illness and substance abuse to the potentially avoidable 30-day readmissions in medical patients. The study’s purpose is to determine the function of psychiatric illness and substance use in the risk for medical readmission.

How do these two articles support the nurse practice issue you chose?

According to the objectives of the two studies, it is clear that both studies are set to find the relationship between readmissions and psychiatric illness and substance use, and other factors that affect readmissions and how to reduce the risk. Antony et al. (2018) found that the participants cited structural barriers such as the inability to access primary care providers and restricted involvement of care providers in medical choices as the main factors, although some thought that readmission could not be prevented (Antony et al., 2018). The study found that the most effective intervention was to increase primary care providers during medical decision-making about readmission alongside effective communication between patients and their families (Antony et al., 2018).

Burke et al. (2013) found that patients treated for mental illnesses were at a higher risk of avoidable readmissions, while outpatient clients prescribed with psychiatric medication were at a higher risk for all-cause readmissions. The study suggests that inpatient medical providers’ compulsory community treatment and follow-up would be helpful interventions to reduce readmission risk (Burke et al., 2013). These interventions relate to the PICOT question since they are non-treatment options that would help reduce readmissions in mental illness patients.

Method of Study

In the article by Antony et al., the study was qualitative and purposive sampling. It was applied to employ potential veteran affairs (VA) patients who were above 18 years, readmitted within the last 30 days after discharge, and were mentally competent to give consent and were medically stable. The participants were determined through a retrospective chart review, and a talk was held with the ward nurse for admissibility (Antony et al., 2018). After that, interviews of between 20-30 minutes were held, and audiotapes and all participants gave their written consent. An advantage of using the interviews was that it identified essential contextual factors that would not be otherwise found in a qualitative study (Antony et al., 2018). However, the study involved a small sample size through a non-probability method that limited the probability of generalization. Moreover, the study mostly involved Caucasian male patients; therefore, it would not accurately present the theme across all VA patients and females.

The study by Burke et al. (2013) was a reflective group study of repeated adult patients cleared from the Brigham and Women’s Hospital. The study used a mixture of inpatient and outpatient administrative and clinical data to recognize study participants. Patients were excluded if they left against medical advice or were discharged to another facility. The exclusion was also made in the case of death within the facility. The study approach allowed for quick identification of a large cohort unaffected by selection bias (Burke et al., 2013). The disadvantage of the study method was that it was single-centered and limited generalization while limiting its ability to diagnose psychiatric disease conclusively. The two study methods differed in sampling methods since one used probability sampling, while the other used non-probability sampling.

Results of Study

In the article by Antony et al., the mean age of the participants was 71.6 years, with all participants having previous medical situations or accounts of mental disorders. Of the 18 participants, 17 were male and one female (Antony et al., 2018). The participants noted that inaccessible care providers and limited care provider involvement in their readmissions contributed to their readmissions. However, there were some that thought that readmission was inevitable.

In the article by Burke et al., there were 1260 readmissions out of 6987 discharged patients (18%), where 5.6% (388) readmissions were potentially avoidable. The multivariate analysis found that two or more prescribed outpatient psychiatric drugs were related to increased all-cause readmissions. In contrast, the discharge diagnosis of substance abuse or anxiety was related to fewer all-cause admissions (Burke et al., 2013). According to Antony et al., (2018), strategies such as proactive post-discharge outreach for high-risk patients, increased access for patient care, and patient education was essential in light of the results. The study by Burke et al. suggests that their findings be used to stratify patients in hospital facilities in terms of risk.

Ethical Considerations

Ethical considerations in research involve processes such as protecting the rights of the subjects, and publication of research information. Some of the issues include informed consent and respect for anonymity and confidentiality. Informed consent means that the participants are fully aware of their participation in the research, and knowingly agree to participate by giving a clear and manifest consent. In the article by Antony et al., the participants gave a written consent form, which they submitted before the study commenced (Antony et al., 2018). Respect for confidentiality and anonymity is expressed when a person’s identity is not connected to their responses, and the participant’s identity is protected. Moreover, both studies ensured confidentiality and anonymity by protecting personal information and only publishing medical information relevant to the studies. The study participants’ identities were not revealed in the studies.

References

Antony, S. M., Grau, L. E., & Brienza, R. S. (2018). A qualitative study of perspectives concerning recent rehospitalizations among a high-risk cohort of veteran patients in Connecticut, USA. BMJ Open8(6), e018200. https://doi.org/10.1136/bmjopen-2017-018200

Burke, R. E., Donzé, J., & Schnipper, J. L. (2013). Contribution of psychiatric illness and substance abuse to 30-day readmission risk. Journal of Hospital Medicine8(8), 450-455. https://doi.org/10.1002/jhm.2044

Running Head: QUANTITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATIONS

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CRITIQUE 2

Quantitative Research Critique and Ethical Considerations

Angelique Christoffel

Grand Canyon University

Nurs 433V

June Helbig

August 30, 2020

Quantitative Research Critique and Ethical Considerations

Article ‘Reducing Behavioral Inpatient Readmissions for People with Substance Use Disorders: Do Follow-up Services Matter’ is written by Reif, S., Acevedo, A., Garnick, D. W., & Fullerton, C. A. (2017) and they have evaluated the effectiveness of the follow-up which extended for the period of fourteen days among the people who had a problem of substance abuse and this follow-up took place after the discharge from the hospital. It has been found out that readmission is common among the patients having the problem of substance abuse which is major because of the lack of any kind of subsequent communication between the patients and doctors after their discharge.

Background of Study

The research question in the article aims at evaluating the effectiveness of the services provided in the follow-up sessions. The article ‘Inpatient Addiction Consultation for Hospitalized Patients Increases Post-Discharge Abstinence and Reduces Addiction Severity’ is written by Wakeman, S. E., Metlay, J. P., Chang, Y., Herman, G. E., & Rigotti, N. A. (2017) in which they assessed the impact of the hospital-based intervention among people who had a problem of drug use and alcohol use during their hospital visits. People suffering from substance abuse a mostly taken care of in the general medical setting. The hospital-based intervention for such patients also included the addiction consultation in the inpatient setting and research has shown that such interventions can improve the outcomes. The interventions which include the consultation and follow-up settings are usually performed by the nurses who significantly increase the value of their profession and they are given more responsibility that becomes beneficial for them. My research question is as follows: 

“In mental health patients with substance use disorders (P), does treatment, (I) as compared to non-treatment, (C), reduce readmissions, (O) within 90 days?”

The effectiveness of the intervention treatment in the patients with substance abuse will be evaluated in my research study and the hypothesis states that such intervention can reduce the chances of readmission back to the hospitals among the patients with the problem of drug and alcohol abuse. Addiction is the worst thing and once people get addicted, it becomes harder for them to leave their dependence and stay clean even when they are given the medical and hospital interventions. It has been found out that lack of medical consultation in the follow-up increases the risk of readmission. Therapies are also found effective in reducing dependence among patients with substance abuse. The selected articles for this assignment had chosen two different interventions and their impact on the readmission among patients. Interventions include hospital-based intervention including therapy and consultation and fourteen days follow-up. These studies will find out the impact of any kind of intervention which will assist in answering the selected research problem. The time periods in which interventions are monitored are different from the one selected in PICOT but that will help the question because the selected time period is more than what is being evaluated in the assignments. The intervention plan includes the follow-up and the consultation in addition to providing the regular services. The comparison groups’ selection is also on point because patients suffering from alcohol and drug use from different age groups are selected in these studies. 

How do these two articles support the nurse practice issue you chose?

The sample selected in the study ‘Reducing Behavioral Inpatient Readmissions for People with Substance Use Disorders: Do Follow-up Services Matter’ includes people from the age of 18 to 64 suffering from the problem of substance abuse and along with that inclusion criteria included their inpatient hospital stay and residential detoxification. The intervention plan includes residential and outpatient treatment, medication-assisted treatment, and intensive outpatient treatment. The intervention was conducted and evaluated in people belonging to ten different states and was given index admission numbers and follow-up prevalence services. Survival analyses were conducted in which time-variant independent variables were analyzed and at the same time connection of follow-up services with the medication-assisted treatment was assessed in relation to the behavioral health readmissions frequency. People from different age groups were added into this study which is a plus point because the impact of different people will be evaluated but it has a negative point of having a different time frame than the research question. 

Method of Study

The prospective quasi-experiment for the thirty days post-discharge is conducted in people having additional consultation from doctors and the ones without any kind of consultation in the article ‘Inpatient Addiction Consultation for Hospitalized Patients Increases Post-Discharge Abstinence and Reduces Addiction Severity’. The people from urban academic hospitals were evaluated and selected which were a total of 399 adults. The intervention used for them had a multidisciplinary approach including pharmacotherapy initiation, motivational counseling, relation with the ongoing addiction treatment, and treatment planning. The calculation was conducted on the basis of the Addiction Severity Index (ASI). The inclusion of people from different age groups was a plus point but the limitation of the time frame poses a negative challenge to the chosen research problem. 

Results of Study

The results of ‘Reducing Behavioral Inpatient Readmissions for People with Substance Use Disorders: Do Follow-up Services Matter’ showed that twenty-nine percent of patients got the follow-up checkup who had behavioral health admission before. However, the combination of residential treatment and medication-assisted treatment improved their overall outcomes and decreased their chances of getting readmission again in three months. At the same time, the ones without outpatient follow-up became more vulnerable to the chances of readmission. The conclusion stated that such medication-assisted treatment and residential treatment after the inpatient treatment and detoxification minimizes the risk of future readmission and hence it is recommended to the Medicaid programs to improve their residential treatment and medication-assisted treatment.

The results of ‘Inpatient Addiction Consultation for Hospitalized Patients Increases Post-Discharge Abstinence and Reduces Addiction Severity’ showed that patients in the intervention group getting the follow-up sessions have decreased ASI composite score. Results remained the same in people belonging to different genders, ages, and severity of diseases but the people without any kind of follow-up were found out to be vulnerable to readmission. Therefore the addiction consultation was found to be effective in reducing the chances of getting addicted to alcohol and substance abuse. The chosen research studies presented that any kind of information including the consultation and follow-up decreases the pressure from the medical profession because fewer people are readmitted again and hence it also helped in signifying the importance of nurse’s intervention. 

Ethical Considerations

Therefore, it is found out that there is a correlation between the reduced readmissions and the intervention treatments in the form of follow-ups. The anticipated outcome of the research suggests that intervention in the form of treatment in people suffering from substance abuse can minimize the chances of readmission in hospitals due to the same reason in ninety days. The selected studies have shown that intervention in form of the addiction consultation and follow-ups decreases the readmission risk in the people suffering from substance use disorders, which is also the same as the anticipated outcome of my research study. 

References

Wakeman, S. E., Metlay, J. P., Chang, Y., Herman, G. E., & Rigotti, N. A. (2017). Inpatient addiction consultation for hospitalized patients increases post-discharge abstinence and reduces addiction severity. Journal of general internal medicine32(8), 909-916. https://doi.org/10.1007/s11606-017-4077-z

· Reif, S., Acevedo, A., Garnick, D. W., & Fullerton, C. A. (2017). Reducing behavioral health inpatient readmissions for people with substance use disorders: do follow-up services matter? Psychiatric services68(8), 810-818. 10.1176/appi.ps.201600339