Evidence-Based Practice: Validated Sources for Nurses' Skills & Knowledge - Essay Sample

Introduction

Evidence Based Practice (EBP) involves the use of research and analytical capacity skills to identify and reflect the best and most effective practices of providing clinical care (Kang, 2016). Nurses require the right skills and knowledge to solve challenges that they may face in their daily experiences. Sources of acquiring these critical life elements, therefore, require careful selection. The sources should be proved effective or validated to offer high-quality results. Different scenarios present decision making difficulty especially considering that not all outcomes can be accurately expected. It is therefore important to conduct background research on the right interventions known to have been effective during various health conditions. In this regard, EBP enables nursing practitioners to apply interventions that have been tested and proven effective with the goal of improving health care service delivery. Improved clinical expertise is an important goal in healthcare and is easily achieved by embracing research related to healthcare delivery.

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Advanced practice nurses require the right skills and knowledge to solve challenges that they may face in their daily experiences. Different scenarios present decision making difficulty especially considering that not all outcomes can be accurately expected. Improved clinical expertise is an important goal in healthcare, which can be easily achieved by embracing research related to healthcare delivery. Sources of acquiring these critical life elements, therefore, require careful selection. The sources should be proved effective or validated to offer high-quality results. It is therefore important to conduct background research on the right interventions known to have been effective during some health conditions.

Iowa Model of Evidence-Based Practice

Iowa Model (1994) is one of the four EBP models have been described that are the most frequently referenced. The Iowa Model was developed jointly in 1994 by the University of Iowa, University of Iowa hospitals and clinics and the College of Nursing. In this model, the term trigger is used to designate alert terms that describe symptoms indicating that there is a problem or there is a need to answer a question. Starting with a trigger, the model begins by identifying a problem or need to answer a question. For this, a bibliographic search is carried out and if an answer is not found, the design of an investigation is carried out to find the answer. The results of this investigation are later embedded within the knowledge that was already on the subject. If the study cannot be carried out, the alternative to review expert opinions, case studies, etc. is considered and a guide is produced to be evaluated and tested.

PICOT Question

In patients who are addicted to opioids (P), is treatment with Vivitrol injections more effective (I) in preventing relapse to opioid dependence (O) than those prescribed Suboxone(C)?

PICOT Statement

The fight against the opioid abuse epidemic has increased the need for medical treatment in the United States. The presence of chronic pain is associated with an inadequate response to addiction treatment. To treat patients with opioid dependence, exchange for Suboxone (buprenorphine and naloxone) is usually performed. The studies also recommended that patients should receive multidisciplinary treatment for opioid dependence and chronic pain, which include psychotherapies, self-help groups, and cognitive behavioral therapy.

Suboxone (synthetic opioid antagonist) is commonly used in hospital emergencies when opiate dependence is suspected (opioid desensitization test) and is started by injecting very small doses to verify that indeed -or not- there are symptoms related to the withdrawal syndrome; since initially, in higher doses, it can be dangerous and even lethal, depending on the degree of intoxication in which the patient is. Suboxone appears to precipitate a withdrawal syndrome in opiate addiction. However, in alcohol consumption, Vivitrol injections- which is also an opiate antagonist - decreases this craving effect.

It has been hypothesized that alcohol stimulates endogenous opiate activity (that is, that drinking is very reinforcing); so unlike other types of dependence on other substances, in cases of alcohol detoxification or alcohol dependence, not only endocannabinoids and endogenous opiates are involved, but also several neurotransmitters (GABA, glutamate, dopamine), which constitutes a more complex process that has added the positive reinforcement of the psychological rehabilitation programs and the motivation to abandon alcohol consumption (. Experimental and clinical studies have suggested the efficacy of opioid antagonist treatments in alcohol dependence, showing that there is a primary endogenous dysfunction (deficiency) of the endorphin and enkephalin systems in people who spontaneously consume alcohol; on the other hand, it is also known that the administration of alcohol alters the content of brain endorphins and enkephalins.

Therefore, Vivitrol injections turn out to be so effective reducing the craving or longing to consume alcohol, since what it produces is to antagonize the reinforcing effect (pleasant, anxiolytic, euphoric, etc.) that alcohol intake produces; whereas in the other "harder" drug units, antagonization of opioid receptors especially produces the unpleasant effects of the absence of the opiate (withdrawal syndrome) if the guidelines indicated above are not followed.

Neuronal sensitization in the dopaminergic system has been hypothesized to fundamentally appear to be the neurobiological mechanism responsible for addiction and craving. In this sense, Vivitrol injections seem to reduce the release of dopamine in the nucleus accumbens, modulating dopaminergic sensitization. On the other hand, it has also been indicated that relapses in alcohol intake could be due to an abnormally low level of central endorphins as a consequence of a feedback phenomenon due to the acute increase in endorphins produced by chronic alcohol consumption.

Evidence Hierarchy

The practice of EBP is a continuous learning process in nursing professional life. It teaches NPs about the care that they must have with patients, creating, in turn, the need to be able to discern the importance in the information provided in the medical literature with reference to diagnosis, prognosis, treatment and other aspects of health care. The fundamental step for the clinical application of the evidence around a clinical problem is to give a value to the available evidence that allows exercising clinical judgment based on the degree of reliability that the results of scientific research provide and that allows to evaluate benefits vs. risks, in light of current evidence.

There are multiple proposals for classifications to assess the evidence. Along with this, the epidemiological language used has led to confusion and misunderstanding on the part of clinical doctors, who see in this great variety of options more conflicts that define the development of professional practice. However, the interesting thing about all this is that the increasing development of clinical guidelines and the performance of health technology evaluations has determined the need to use each of the aforementioned initiatives, both in universities and health facilities; reason for which it is relevant to know them, in order to better understand the methodology through which these processes are carried out.

The systematization of the search for evidence is the fundamental step to obtain the best available evidence. However, when approaching it, the existence of population, cultural, economic, technological, environmental characteristics, etc. must always be considered; that is, to give relevance to the concept of external validity "regardless of" what "seems to result" in other latitudes, without prior evidence in our reality. The next step corresponds to giving value to this evidence, for which the classification that best suits our needs and that allows discriminating between one level and another must be chosen, to make the most appropriate recommendations for the healthcare and population environment.

Literature Review

In the United States, the overdose of opioids has become the leading cause of accidental death which has been the great public health challenge of recent years. Substitution-based treatment - now called "opioid agonist treatment" (OAT) because it is considered less stigmatizing aims to replace the illicit use of opioids with a prescription within a well-defined legal framework. It is recognized in the literature to be efficient in terms of health economics.

Opioids are the drugs of choice for the relief of acute pain and severe cancer pain and have also been used in treating several chronic non-cancer pain syndromes. Although their use for chronic non-cancer pain is controversial, there is growing evidence of benefit in some patient populations. The great fear of prolonged use of opioids for these patients is that, despite having an excellent analgesic effect, there is a substantial increase in the risk of the main complication, which is addiction.

The integrated management of opioid addiction, including risk reduction and the multidisciplinary approach, makes it possible, among other things, to improve the health of patients, to reduce the transmission of diseases and reduce crime. However, a significant proportion of overdose deaths are due to the misuse of prescribed opioids, including OATs, and to avoid them, they should be prescribed in accordance with the recommendations. The primary care physician, through his global approach to the clinical situation, is a privileged player in the support of opioid-dependent patients.

Jarvis et al. (2018) conducted a systematic quantitative review that synthesized the findings of previous studies concerning the use of Vivitrol in the treatment of opioid dependence. Among the significant findings of this systematic review was that Vivitrol treatment for opioid dependence has been proven to be effective in decreasing the use of opioids, induction to treatment has been proven successful, as well as, adherence rates.

Kampman and Jarvis (2015) evaluated the guidelines that provide information on evidence-based treatment of opioid use disorder. To reduce the risk and obtain a better effect of opioids, the guidelines emphasize the necessity for professionals to administer the medication consciously, with precise indications, making periodic evaluations. The prolonged use of opioids causes numerous cellular changes responsible for the development of three clinical phenomena: tolerance, withdrawal syndrome and dependence (Banta-Green et al., 2019).

Lee et al. (2018) conducted an open-label, multicenter, randomized controlled trial to compare the effectiveness of extended-release naltrexone against buprenorphine-naloxone in the prevention of opioid relapse. Like Jarvis et al. (2018) study, significant findings of this study were that naltrexone (XR-NTX) and buprenorphine-naloxone (BUP-NX) were comparably effective and safe options. However, in those taking BUP-NX, 57% relapsed during the study, which was significantly less than the 65% who relapsed taking XR-NTX. Banta-Green et al. (2019) conducted a randomized control trial to determine the feasibility of the intervention of introducing medications for opioid use disorder and psychosocial support after opioid-dependent inmates are released from custody. In the feasibility study, 15 participants enrolled from Washington State prisons. All were male, primarily white Caucasian, and averaged 36.9 years old. 14 out of the 15 participants were heroin users with a history...