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.

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

PEER #1

Shaunagay Kenney

Week 7 Discussion Main Post

A Critical Question with Measurable Outcomes

Question: Will adding pharmacological interventions to nonpharmacological treatments improve post-traumatic stress disorders in adults?

Article Selection

A total of six articles were discovered and appraised using the “Adapted Rating System for the Hierarchy of Evidence” (Dang & Dearholt, 2017; Fineout-Overholt et al., 2010). The type of article and information that supported the purpose statement were used in the selection process.

Critical Question Explanation

            Post-traumatic stress disorder (PTSD) has long been associated with military members

exposed to combat. Before PTSD was coined, Charles Myers used shell “shock” to describe injured soldiers during World War I (Horwitz, 2018). According to Friedman (2019), PTSD is defined as direct or indirect exposure to a traumatic event where a person is severely traumatized based on that event. According to the National Center for PTSD (2021), 60% of men and 50% of women will experience at least one traumatic event in their lives, 6% of the population will have PTSD at some point in their lives, and about 15 million adults have PTSD during a given year. For most individuals, psychotherapy is a sufficient treatment for PTSD, but not for others. Could pharmacological interventions assist individuals where psychotherapy alone does not work?       

Article Synthesis

            For some individuals, psychotherapy alone does not work. Similarly, pharmacological use alone can be ineffective (Raskind et al., 2018; Rasmusson et al., 2017). However, combining SSRIs or other medications with CBT or other therapies may reduce PTSD symptoms in some individuals (Mithoefer et al., 2019; Wagner et al., 2017). Mithoefer et al. (2019) found that MDMA- assisted psychotherapy effectively treated PTSD. According to Wagner et al. (2017), MDMA increases oxytocin, facilitates openness, and enhances the therapy's effectiveness. In the prolonged exposure and sertraline trial conducted by Rauch et al. (2020), PTSD subjects were given strict instructions on collecting their saliva for testing. They made a ground-breaking discovery about cortisol, finding that cortisol levels were lower in individuals with PTSD than those without PTSD (Rauch et al., 2020). Not only was this discovery made, but following the combination treatment of sertraline and prolonged exposure, significant improvements were noted for one year (Rauch et al., 2019). While combining psychotherapy with some drugs improved PTSD symptoms, others did not.

References

Dang, D., & Dearholt, S. (2017). 
Johns Hopkins nursing evidence-based practice: Model and     guidelines (3rd ed.). Sigma Theta Tau International.

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B. & Williamson, K. M. (2010). Critical   

           appraisal of the evidence: Part I. 
American Journal of Nursing, 110(7), 47-52. 

https://doi.org/10.1097/01.NAJ.0000366056.06605.d2Links to an external site.

Friedman, M. J. (2019, October 14). 
PTSD History and Overview. U.S. Department of Veterans Affairs. 

https://www.ptsd.va.gov/professional/treat/essentials/history_ptsd.aspLinks to an external site.

Horwitz, A. (2018). 
PTSD: A short history. Johns Hopkins University Press

Mithoefer, M. C., Feduccia, A. A., Jerome, L., Mithoefer, A., Wagner, M., Walsh, Z., Hamilton,     S., Yaza-Klosinski, B., Emerson, A., & Doblin, R. (2019). MDMA-assisted psychotherapy for treatment of PTSD: Study design and rationale for phase 3 trials based   on pooled analysis of six phase 2 randomized controlled trials. 
Psychopharmacology,            236(9), 2735-2745. 

https://doi.org/10.1007/s00213-019-05249-5Links to an external site.

PTSD: National Center for PTSD. (2021, September 10). 
How common is PTSD in adults? U.S.       Department of Veterans Affairs.        

https://www.ptsd.va.gov/understand/common/common_adults.aspLinks to an external site.

Raskind, M. A., Peskind, E. R., Chow, BB., Harris, C., Davis-Karim, A., Holmes, H. A., Hart, K.    L., McFall, M., Mellman, T. A., Reist, C., Romesser, J., Rosenheck, R., Shih, M. C.,           Stein, M. B., Swift, R., Gleason, T., Lu, Y., & Huang, G. D. (2018). Trial of prazosin for     post-traumatic stress disorder in military veterans. 
The New England Journal of         Medicine, 378(6), 507-517. 

https://doi.org/10.1056/NEJMoa1507598Links to an external site.

Rasmusson, A. M., Marx, C. E., Jain, S., Farfel, G. M., Tsai, J., Sun, X., Geracioti, T. D.,    Hamner, M. B., Lohr, J., Rosse, R., Summerall, L., Naylor, J. C., Cusin, C., Lang, A. J.,         Raman, R., & Stein, M. B. (2017). A randomized controlled trial of ganaxolone in   post-traumatic stress disorder
. Psychopharmacology, 234(15), 2245-2257.            

https://doi.org/10.1007/s00213-017-4649-yLinks to an external site.
 

Rauch, S. A. M., Kim, M., Powell, C., Tuerk, P. W., Simon, N. M., Acern, R., Allard, C. B.,         Norman, S. B., Venners, M. R., Rothbaum, B. O., Stein M. B., Porter, K., Martis, B.,            King, A. P., Liberzon, I., Luan Phan, K., & Hoge, C. W. (2019). Efficacy of prolonged        exposure therapy, sertraline hydrochloride, and their combination among combat veterans             with post-traumatic stress disorder. 
JAMA Psychiatry, 76(2), 117-126.             

https://doi.org/10.1001/jamapsychiatry.2018.3412Links to an external site.

Rauch, S. A. M., King, A., Kim, H. M., Powell, C., Rajaram, N., Venners, M., Simon, N. M.,   Hamner, M., & Liberzon, I. (2020). Cortisol awakening response in PTSD treatment:     Predictor or mechanism of change. 
Psychoneuroendocrinology, 118, 1-16.             

https://doi.org/10.1016/j.psyneuen.2020.104714Links to an external site.

Wagner, M. T., Mithoefer, M. C., Mithoefer, A. T., MacAulay, R. K., Jerome, L., Yazar-      Klosinski, B., & Doblin, R. (2017). Therapeutic effect of increased openness:  Investigating mechanism of action in MDMA-assisted psychotherapy. 
Journal of  Psychopharmacology, 31(8), 967-974. 

https://doi.org/10.1177%2F0269881117711712Links to an external site.

PEER # 2

Samir Moneer Nawaf Hamed

 

Critical Question: Nursing burnout and its impact on nurses and patient care.

Nursing burnout is a state of emotional, physical, and mental exhaustion resulting from prolonged and intense stress in the nursing profession. It significantly impacts nurses by causing increased job dissatisfaction, higher turnover rates, and adverse mental and physical health effects (Mudallal et al., 2017). Moreover, burnout has a direct and detrimental impact on patient care, leading to decreased quality, increased medical errors, and reduced patient satisfaction due to compromised nurse-patient interactions and reduced attention to detail (Garcia et al., 2019). Addressing nursing burnout is crucial for maintaining a resilient nursing workforce and ensuring high-quality patient care outcomes.

Synthesis of Scholarly Articles

1. Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis

This study comprehensively analyzed existing research and found compelling evidence that burnout among healthcare professionals significantly impairs patient safety. The meta-analysis synthesized data from multiple studies, revealing a strong association between burnout and increased risks of medical errors, compromised quality of care, and adverse patient outcomes, highlighting the critical importance of addressing burnout as a crucial factor in ensuring patient safety in healthcare settings (Garcia et al., 2019).

2. Relationship between nurse burnout, patient and organizational outcomes: Systematic review

This study examined a broad range of studies and revealed a clear and intricate relationship between nurse burnout, patient outcomes, and organizational effects. It found that higher levels of nurse burnout are consistently linked to adverse patient outcomes such as increased mortality rates, longer hospital stays, and decreased patient satisfaction. Additionally, burnout has detrimental organizational consequences, including higher nurse turnover and lower overall workplace performance. This study underscores the interconnectedness of nurse well-being, patient care quality, and organizational success, emphasizing the urgency of addressing burnout to improve healthcare outcomes and workplace environments (Jun et al., 2021).

3. Nurse Burnout and Quality of Care: Cross-National Investigation in Six Countries

This study conducted a comprehensive cross-national analysis and identified a consistent and alarming pattern: nurse burnout substantially negatively impacts the quality of patient care across different healthcare systems and countries. The study's findings highlighted that high levels of nurse burnout were associated with lower perceptions of care quality among both nurses themselves and patients. This suggests that addressing nurse burnout is imperative not only for the well-being of healthcare professionals but also for maintaining and improving the quality of care delivered in diverse healthcare settings globally (Poghosyan et al., 2021).

4. Association of resident fatigue and distress with perceived medical errors

This study demonstrates a significant correlation between resident physician fatigue and distress levels and the perception of medical errors. The research findings suggest that higher levels of resident fatigue and distress are associated with increased instances of perceived medical errors. This indicates that addressing the well-being and mental health of healthcare providers, including reducing fatigue and distress, can play a crucial role in improving patient safety and reducing the likelihood of medical errors in healthcare settings, emphasizing the need for interventions and policies aimed at mitigating these factors to enhance patient care quality. (West, 2019)

Value for Stakeholders

Addressing nursing burnout is a moral imperative and a strategic quality improvement initiative. The identified articles provide compelling evidence that nurse burnout directly impacts patient satisfaction, healthcare outcomes, and organizational effectiveness (Mudallal et al., 2017). By investing in interventions to reduce burnout, healthcare organizations can enhance patient care quality, increase staff retention, reduce medical errors, and ultimately improve their bottom line. Moreover, addressing nursing burnout aligns with the mission of healthcare organizations to deliver safe, effective, and patient-centered care, enhancing their reputation and competitiveness in the healthcare industry (Jun et al., 2021).

 

References

Garcia, C. de L., Abreu, L. C. de, Ramos, J. L. S., Castro, C. F. D. de, Smiderle, F. R. N., Santos, J. A. D., & Bezerra, I. M. P. (2019, August 30). Influence of burnout on Patient Safety: Systematic Review and meta-analysis. Medicina (Kaunas, Lithuania). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780563/

Jun, J., Ojemeni, M., Kalamani, R., Crecelius , M., & Tong , J. (2021, March 26). Relationship between Nurse Burnout, patient and organizational outcomes: Systematic review. International Journal of Nursing Studies. https://www.sciencedirect.com/science/article/abs/pii/S0020748921000742

Mudallal, R. H., Othman, W. M., & Al Hassan, N. F. (2017, January 1). Nurses’ burnout: The influence of leader empowering behaviors, work conditions, and demographic traits. Inquiry : a journal of medical care organization, provision and financing. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798741/

Poghosyan, L., Clarke, S. P., Finlayson, M., & Aiken, L. H. (2021, August). Nurse Burnout and quality of care: Cross-national investigation in six countries. Research in nursing & health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908908/#:~:text=Across%20countries%2C%20higher%20levels%20of,quality%20of%20care%20in%20hospitals.

West, C. (2019, September 23). Association of resident fatigue and distress with perceived medical errors. JAMA. https://jamanetwork.com/journals/jama/article-abstract/184625