Description
INTRODUCTION
Building off your earlier work in Assessment 4, where you defined your gap in practice, and Assessment 5, where you provided evidence to substantiate it, now it is time to decide what intervention will best address the problem.
In this assessment, you will decide on an intervention to present to stakeholders and collect evidence to substantiate the selected intervention.
DEMONSTRATION OF PROFICIENCY
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
Competency 3: Address assessment purpose in a well-organized text, incorporating appropriate evidence and tone in grammatically sound sentences.
Construct an introduction that provides an overview of your gap in practice and ends with a PICOT question in the correct format, and is an appropriate scope for a DNP project.
Produce text with minimal grammar, usage, spelling, and mechanical errors.
Apply APA formatting to in-text citations and references.
Competency 5: Synthesize literature to support a possible intervention or process change.
Identify at least five recent research articles that provide information or insight about a specific intervention that addresses the practice gap.
Summarize recent research articles by completing an evidence table.
Provide a critical review of all chosen articles, including methodology, research questions, theoretical basis, and findings.
Synthesize the evidence using the MEAL plan format.
Evaluate the quality of the evidence, including strengths and weaknesses.
Note: The assessments in this course must be completed in the order presented; subsequent assessments should be built on both your earlier work and your instructor’s feedback on earlier assessments. If you choose to submit assessments prematurely, without considering and integrating your instructor’s feedback, your assessment may be returned ungraded, resulting in your loss of an assessment attempt.
INSTRUCTIONS
In Assessment 5, you defined and substantiated a practice gap or problem at your practice site that has the appropriate scope for a DNP project. In Assessment 6, it is time to collect evidence to substantiate a possible intervention. Being able to find recent peer-reviewed, relevant literature to support your findings, or to support a need for interventions, is a vital part of gaining stakeholder support.
PREPARATION: EVIDENCE TABLE
For this part of the assessment, use the Evidence Table Template [DOCX] to list articles that will help you substantiate an intervention for your chosen practice gap or problem.
Search the library databases for a minimum of five peer-reviewed articles that substantiate an intervention for your chosen practice gap or problem. Complete the evidence table fully for these articles, providing all the required information.
Identify five keywords that relate to a specific practice gap in the PICOT question.
Conduct a literature search using the keywords and select at least five relevant, recent research articles (published within the past five years) that provide information or insight about the intervention.
Create an evidence table and complete each column for each research article.
Add the evidence table as an appendix to this assessment.
PART 1: INTRODUCTION AND REVISED PICOT QUESTION
Begin your synthesis with a brief introduction (1–2 paragraphs) that addresses the following:
An overview of your gap in practice.
An explanation of the intervention you have chosen to research.
End the paragraph by stating your PICOT question, which you have revised using the feedback you received in Assessment 4.
Make sure your PICOT question is in the correct format, all components are well aligned, and it has an appropriate scope for a DNP project.
PART 2: CRITICAL REVIEW OF LITERATURE
For the second part of the assessment, provide a critical review of each of the articles you included in the evidence table.
For each article, write a one-paragraph critique that addresses the following:
Provide a one-sentence overview of the main point of the article.
Be sure each article is correctly formatted in APA format. The author’s last name and date should be used to identify each article, rather than the article title.
Provide the research questions and discuss the research methodology used.
If the research question is not specified, provide the aim of the study instead.
Analyze the theoretical basis and/or conceptual framework used in the study, if described in the study.
Critically appraise the study using one of the following:
SORT.
Johns Hopkins.
What is GRADE?
Report on the study findings and propose a possible application this article could have to your own project topic.
Length: 3–4 pages.
PART 3: SYNTHESIS OF LITERATURE
You have done a great job of collecting a lot of information to substantiate your chosen intervention. Now it is time to summarize the information, reach conclusions, and link the resources that you found. In other words, a synthesis is akin to combining the parts to make a whole. This is accomplished by asking yourself, what is the main point(s) that the selected research articles have in common? Thus, following the MEAL plan, you will write a topic sentence for this section that makes a main point, which is supported and explained by all of the articles you selected. If you devote one paragraph to an entire article, you are creating an annotated bibliography, which is helpful for your personal use to keep track of your articles, but it is not a synthesis of the literature. This skill will be important for you to master before you create your project charter, which must be written professionally, yet succinctly.
For the third part of the assessment, provide a brief synthesis (1–2 paragraphs) of the information you have collected from the five articles you chose.
In your synthesis of the literature:
Following the MEAL Plan, synthesize the intervention using all five articles to clearly identify the intervention.
The paragraph should be in your own words and should not include quotes.
PART 4: EVALUATE QUALITY OF LITERATURE
An important aspect of conducting research is the ability to evaluate the strengths and weaknesses of the sources you intend to use to support your ideas.
In this section, address the following:
Consider the strengths and weaknesses of the evidence you have collected thus far.
Discuss the collective quality of the evidence.
Identify other areas you need to investigate to be able to apply this intervention.
Are there alternative interventions that could also work?
Do you have any unanswered questions?
Are there any areas where further research is needed to find an appropriate solution for this gap in practice?
Length: 1 page, maximum.
ADDITIONAL REQUIREMENTS
Length: 4–6 pages, not including title page or evidence table.
Organization: Use level headings, except for the introduction.
Appendix: Include evidence table as an appendix.
GRADING CRITERIA
Your assessment will be graded using the following scoring guide criteria:
Construct an introduction that provides an overview of your gap in practice, and ends with a PICOT question in the correct format, and is an appropriate scope for a DNP project.
Identify at least five recent research articles that provide information or insight about a specific intervention that addresses the practice gap.
Summarize recent research articles by completing an evidence table.
Provide a critical review of all chosen articles, including methodology, research questions, theoretical basis, and findings.
Synthesize the evidence using the MEAL plan format.
Evaluate the quality of the evidence, including strengths and weaknesses.
Produce text with minimal grammar, usage, spelling, and mechanical errors.
Apply APA formatting to in-text citations and references.
Unformatted Attachment Preview
Evidence Table
Search the Capella library databases for a minimum of five research articles that you will use to support your practice gap
(Assessment 5) or your intervention (Assessment 6). Each article must be relevant and published within the past five years.
Complete the evidence table fully for these articles, providing all the required information. Include this table as an appendix to your
assessment.
Citation
Conceptual
Framework
Design/
Method
Sample/
Setting
Major Variables
Studied and their
Definitions
Measurement
Data
Analysis
Findings
Appraisal: Worth
to Practice
EXAMPLE
Harne-Britner et al.
(2011)
Change theory in
combination with
aspects of behavioral,
social science, and
organizational
theories by Bandura,
Skinner, and Lewin
Quantitative
research
Quasi-experimental
study
Random assignment
of 3 nursing units
into 2 experimental
groups and 1 control
group
Aims of the study
were to determine (1)
the effectiveness of
educational and
behavioral
interventions on
improving HH
adherence; (2)
whether
improvements in HH
adherence were
sustained 6 months
post intervention; and
(3) the relationships
between HH
adherence and HAI
rates on study units.
RNs and patient care
assistants (PCAs)
from 3 medicalsurgical units within
an urban health care
system in
Pennsylvania, USA
A total of 1203
observations (633
RNs and 570 PCAs)
were completed
The control group
received education in
the form of a selfstudy module with a
pre- and posttest.
The experimental
groups received the
same education plus
behavioral
interventions. The
Positive
Reinforcement
Experimental group’s
behavioral
interventions
included individual
and unit rewards for
improved HH
adherence and unitbased recognition by
peers on a sticker
chart. The Risk of
Nonadherence
Experimental group
received additional
educational sessions
about
microorganisms that
are transmitted via
hands
18 data collection
periods per nursing
unit
Data were collected
each month during 3
time frames (5 AM–7
AM, 7:30 AM–9:30
AM, and 3:30 PM–
5:30 PM) reflecting
high work volume to
ensure a
representative sample
SPSS Statistics,
Version 17.0
Chi-square analysis
was used to
determine whether
the 3 nursing units
had similar HH
adherence rates
before any
intervention. The
Fisher exact test was
employed to
determine whether
the change in
adherence rates on
each unit was
statistically
significant.
Education paired
with positive
reinforcement
behavioral
interventions
improved HH
adherence after the
first month (χ2 =
4.27; P = .039); but
the improvement was
not sustained over 6
months. There were
no differences in
infection rates
between the
treatment and control
groups.
Strengths:
-Randomized control
group
-Large sample size
Weaknesses:
-Length of study
Ranking:
Level II
Valid yes
Reliable yes
Applicable yes
Overall rank: High
Reported these data
to the RN and PCA
staff at monthly staffand unit based quality
meetings
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Citation
Conceptual
Framework
Design/
Method
Sample/
Setting
Major Variables
Studied and their
Definitions
Measurement
Data
Analysis
Findings
Appraisal: Worth
to Practice
OBSERVATION
=Watching one
person having direct
contact with a
patient or handling
patient equipment.
CLEANED HANDS =
Washed at a sink
and/or used alcohol
gel from a dispenser
(e.g., wall mounted,
pocket-sized, or a
bottle that is not wall
mounted) before or
after having direct
contact with a
patient or handling
patient equipment.
AWARE OF
MONITORING: You
told the person you’re
going to observe
them or they verbally
acknowledge that you
are monitoring them
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Citation
Conceptual
Framework
Design/
Method
Sample/
Setting
Major Variables
Studied and their
Definitions
Measurement
Data
Analysis
Findings
Appraisal: Worth
to Practice
3
SORT: Evidence Table of Key Clinical Recommendations
We would like each article to include an Evidence Table (also called “SORT” or “Strength of
Recommendations Table”). This table will help readers understand the main points of your article,
and the strength of evidence that supports its recommendations. The table should contain the
key clinical recommendations and strength of recommendation ratings for your article as shown
in the sample below:
Clinical recommendation
Evidence rating
Comments
Obtain an ECG in patients
presenting with chest
pain.1,2
C
Based on expert opinion and
consensus guideline in the
absence of clinical trials.
Patients with two normal highly
sensitive troponin tests an hour
apart can safely be sent
home.10
B
Based on consistent results
from cohort studies showing
reduced ER length of stay
and no change in mortality.
Patients with chest pain should
immediately receive oxygen
and if not allergic an aspirin
tablet.17,18
A
Based on consistent
evidence from RCTs
showing reduced mortality.
The SORT table is intended to highlight the most important three to seven recommendations from your
article for clinicians. Each recommendation must be accompanied by a SORT rating of A, B, or C as
defined below (for a full description of the SORT system, see https://www.aafp.org/afpsort). Your
recommendations should emphasize interventions and approaches that improve patient-oriented
outcomes (e.g. morbidity, mortality, quality of life) over disease-oriented evidence (e.g. biomarkers,
surrogate endpoints).
•
•
You should have three to seven recommendations. Try to identify a range of
recommendations, for example, one each about screening, prevention, diagnosis, and two
about treatment.
Each statement should be in the form of a recommendation and should not just present a
fact or piece of medical trivia. For example, “Use the Wells score to determine the risk of
•
•
•
DVT in patients with leg pain” is a recommendation, while “Of patients presenting with leg
pain, 16% have a DVT” is not.
An “A” recommendation should be based on consistent evidence of improved patientoriented outcomes from well-designed studies. Use clear, directive language as this is a
recommendation that should be applied to most patients, such as “Patients age 50 to 74
years should receive screening for colorectal cancer.”
A “B” recommendation is based on lower quality evidence of improved patient-oriented
outcomes or inconsistent evidence. These statements should use language such as
“Consider…” or “…is a practice option” or “…may be effective.”
A “C” recommendation is often something that is standard of care, but for which there have
been no clinical trials or trials have only reported disease-oriented outcomes. In this case,
the recommendation statement should reflect the strength of recommendation, and the
“Comment” column should clarify that this is a recommendation “based on expert opinion in
the absence of clinical trials” or “based on evidence from clinical trials with blood pressure
reduction as the outcome.”
If you are not comfortable assigning the strength of recommendation (below), our medical editors will
do that for you.
To rate the strength of evidence supporting key clinical recommendations, please use the following
guidelines:
Strength of
recommendation
Definition
A
Recommendation based on consistent and good quality patient-oriented
evidence*
B
Recommendation based on inconsistent or limited quality patientoriented evidence*
C
Recommendation based on consensus, usual practice, expert opinion,
disease-oriented evidence,** and case series for studies of diagnosis,
treatment, prevention, or screening
* Patient-oriented evidence measures outcomes that matter to patients: morbidity, mortality, symptom
improvement, cost reduction, quality of life.
** Disease-oriented evidence measures intermediate, physiologic, or surrogate endpoints that may or
may not reflect improvements in patient outcomes (i.e., blood pressure, blood chemistry, physiological
function, and pathological findings).
Use the table below to determine whether a study measuring patient-oriented outcomes is of good or
limited quality, and whether the results are consistent or inconsistent between studies:
Type of Study
Study
quality
Level 1
Good
quality
patientoriented
evidence
Level
2 Limited
quality
patientoriented
evidence
Diagnosis
Treatment/Prevention/Screening
Prognosis
Validated clinical
decision rule
Systematic review/meta-analysis of
randomized controlled trials (RCTs) with
consistent findings
Systematic
review/metaanalysis of
good quality
cohort studies
Systematic
review/metaanalysis of highquality studies
High quality individual RCT +
Prospective
cohort study
with good
follow-up
High quality
diagnostic cohort
study *
All or none study ++
Unvalidated
clinical decision
rule
Systematic review/meta-analysis of lower
quality clinical trials or of studies with
inconsistent findings
Systematic
review/metaanalysis of
lower quality
cohort studies
or with
inconsistent
results
Systematic
review/metaanalysis of lower
quality studies or
studies with
inconsistent
findings
Lower quality clinical trial +
Retrospective
cohort study
or prospective
cohort study
with poor
follow-up
Lower quality
diagnostic cohort
study or
diagnostic casecontrol study *
Level 3
Other
evidence
Cohort study
Case-control
study
Case-control study
Case series
Consensus guidelines, extrapolations from bench research, usual practice, opinion,
disease-oriented evidence (intermediate or physiologic outcomes only), and case
series for studies of diagnosis, treatment, prevention, or screening.
* High quality diagnostic cohort study: cohort design, adequate size, adequate spectrum of patients,
blinding, and a consistent, well-defined reference standard.
+ High quality RCT: allocation concealed, blinding if possible, intention-to-treat analysis, adequate
statistical power, adequate follow-up (> 80%).
++ An all-or-none study is one where the treatment causes a dramatic change in outcomes, such as
antibiotics for meningitis or surgery for appendicitis, which precludes study in a controlled trial.
Assessing Consistency of Evidence Across Studies
Consistent
Most studies found similar or at least coherent conclusions (coherence means that
differences are explainable).
or
If high quality and up-to-date systematic reviews or meta-analyses exist; they support
the recommendation.
Inconsistent
Considerable variation among study findings and lack of coherence.
or
If high quality and up-to-date systematic reviews or meta-analyses exist, they do not
find consistent evidence in favor of the recommendation.
Please use the following algorithm for determining the strength of a recommendation based on a
body of evidence (applies to clinical recommendations regarding diagnosis, treatment, prevention, or
screening). Although this provides a general guideline, authors and editors should adjust the strength
of recommendation based on the benefits, harms, and costs of the intervention being recommended.
Again, if you are unsure how to apply these ratings, the medical editors will do this
for you. At a minimum, you should create a summary table with recommendations and references for
each recommendation.
For more information on how to apply these ratings, please see the explanatory article published
in the February 1, 2004, issue of American Family Physician.
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Much improved
Difference between a Quality Improvement (QI) or Project Improvement (PI) Project and
Research Study
School of Nursing and Health Sciences, Capella University
NURS-FPX8045 Doctoral Writing and Professional Practice
Dr. Peggy Soper
August, 2023
Beautiful title page !!!
2
Difference between a Quality Improvement (QI) or Project Improvement (PI) Project and
Research Study
•
You cant use the it word = lacks reader clarity
M (Main Point): The main difference between Quality Improvement (QI) or Project
Improvement (PI) and a research study is that QI/PI projects are focused on improving
performance in a single facility using existing evidence, while research is focused on producing
evidence that can be generalized to practice. LOVE THAT E (Evidence): The proposed
doctoral project is a QI/PI project because it is focused on improving care for an underserved
community rather than systematic investigation. The project outcome aims to fulfill the urgent
need for an outpatient substance abuse program in an underserved community located in Miami,
FL. Research studies often subjective seek to generate new evidence through systematic
investigation, with human subjects’ recruitment but QI/PI projects such as the proposed project
apply current evidence to improve outcomes or practice (Knudsen et al., 2019). A (Analysis):
The generation of new evidence, as in research, is a systematic and closely controlled process of
investigation with the goal of producing evidence that can be used in various facilities or settings
to address the investigation issue. The proposed outpatient substance abuse program in Miami,
FL, aims to improve current substance abuse care in the community rather than produce new
evidence. It is, therefore, a QI/PI project rather than a research study. L (Lead out): QI/PI
projects are ideal for doctoral projects with the aim of healthcare services and practice
improvement, such as the proposed outpatient substance abuse program in Miami. They APA
proclaims when you use the word they you better be discussing human and you are not PI/QI
differ from research because they PI/QI focus on quality improvement rather than generating
new evidence.
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Reference
Knudsen, S. V., Laursen, H. V. B., Johnsen, S. P., Bartels, P. D., Ehlers, L. H., & Mainz, J.
(2019). Can quality improvement improve the quality of care? A systematic review of
reported effects and methodological rigor in plan-do-study-act projects. BMC Health
Services Research, 19, 1-10. https://doi.org/10.1186/s12913-019-4482-6
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Interprofessional Communication and Practice Gap
School of Nursing and Health Sciences, Capella University
NURS-FPX8045 Doctoral Writing and Professional Practice
Dr. Peggy Soper
September, 2023
2
Interprofessional Communication and Practice Gap
Quality improvement (QI) and practice improvement (PI) projects are developed based
on assessing existing gaps in practice and opportunities for improvement. Substance abuse is one
of the crucial topics in community health in the United States, and healthcare professionals strive
to promote access to care for affected people. In Little Havana, Miami, many people with an
addiction or are at risk of addiction do not have access to timely substance use treatment
programs. Improving the current screening for substance use disorders can help promote access
to care. In this paper, a discussion of a gap in practice in substance use programs in Miami,
Florida, and the interprofessional collaboration skills that have been applied in proposing the
change is advanced.
Practice Gap
The identified practice gap is low avoid all use of subjective terms of measure in a APA
exact paper utilization of substance use treatment services despite high subjective addiction rates
in the community. There are several substance use treatment programs in Little Havana and
across Miami. However, few people seek care in these facilities, and most of those do have
severe addiction problems. Despite the presence of substance use treatment services, there is a
gap in how people who need these services access them. Avoid all pronouns The gap is due to
inadequate screening and referral to the available programs. The proposed project will close the
gap by providing screening and brief intervention training. Wait the gap is not enough screening
or not enough resources
You said it both ways
Multiple factors affect access to substance use treatment programs, including
socioeconomic factors and knowledge of the appropriate treatment resources. This project
focuses on the Banyan Health System in Little Havana, FL. The community health organization
has a substance abuse program, but nurses working in the center have reported the lack of
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adequate services in the Little Havana location. Little Havana has a high poverty level, with
around 39.1% of the population living below the poverty line (Briseus et al., 2021). Low-income
populations have relatively high levels of substance abuse and poor access to healthcare services,
leading to poor overall health outcomes (Beech et al., 2021). Stigma and lack of knowledge on
where to go for substance use treatment services are also important determinants of access to
care (Solberg & Nåden, 2020). Socioeconomic challenges can be handled through referral to
appropriate facilities that provide affordable or free services. Stigma and lack of knowledge can
be addressed by normalizing screening for substance use disorders and timely provision of
information on treatment options (Bunn et al., 2019). Timely assessment, brief intervention, and
referral to appropriate treatment may improve access to and utilization of substance use
treatment services.
The proposed project will focus on introducing Screening, Brief Intervention, and
Referral to Treatment (SBIRT) guidelines in Little Havana to improve early detection of
addiction disorders and timely intervention. The PICOT question construct is helpful in clearly
outlining the variables of the QI project. The proposed PICOT question is: For the staff caring
for patients in the community mental health center (P), how does training and policy for routine
Brief Intervention and Referral to Treatment (SBIRT) implementation (I) compared to current
practice (C) affect the use of substance use treatment services (O) in twelve weeks (T)?GOOD
In this question, the proposed intervention is training staff on conducting SBIRT and creating a
policy for SBIRT implementation. The intervention will be based in a Community Mental Health
Center in Little Havana, and the expected outcomes are increased utilization of substance use
treatment services.
Interprofessional Communication
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Open communication lines and shared decision-making facilitated discussions with
healthcare professionals at the health center. Gaining buy-in for projects from other healthcare
professionals requires considering the professionals’ opinions and promoting open
communication lines (Wei et al., 2020). These strategies involve an environment welcoming to
all stakeholders and their opinions. Open communication was achieved by setting up an open
forum, encouraging other staff to voice their opinions, and integrating them in defining the
current gap, as in shared decision-making. The strategies effectively obtained collaboration from
colleagues; in this case, they worked to elicit input into the project plan.
Plain language, demonstrating empathy, and asking open-ended questions facilitated
discussions and interactions when discussing with patients. Culturally competent communication
recognizant of the patient’s experiences will likely produce cooperation and effective
communication (Handtke et al., 2019). This approach to communication can be facilitated by
focusing on patients’ experiences and showing empathy for their struggles. Similarly, asking
open-ended questions allows patients to express themselves extensively and relay their opinions,
contributing to quality improvement efforts. These approaches also integrated consideration of
the health literacy of the target population. This necessitated plain language communication to
ensure patients understand and contribute to the program. Effective communication with patients
has been based on evidence of inclusive and culturally competent care and communication.
The stakeholders’ feedback and ideas helped create a more explicit focus on the program
as a gap in practice. Stakeholder involvement from project commencement is essential in
problem definition (Smith et al., 2020). In this project, nurses and patients were involved, and
their feedback identified the lack of adequate care access. Although patients could be referred for
substance abuse treatment programs, the affordability and accessibility in other locations were
seen as significant barriers for the low-income population in Little Havana. The feedback thus
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identified access and affordability as the main issues to address in this project. Therefore, the
ideas and feedback helped narrow the practice gap definition to a manageable scope and clearly
defined problem.
While in-person discussions were practical, written communication could have been
more effective with the stakeholders in discussing the practice gap. Different modes of
communication should be adopted depending on stakeholder preferences, project focus, and the
need to persuade the target population (Arnold & Boggs, 2019). In this project, a request for
feedback was made through a written notice. No responses were received from either patients or
staff. Alternatively, a short meeting was held with the staff in a verbal and informal setting. This
verbal communication made staff more receptive and willing to discuss the issue further.
Similarly, a short conversation with patients as they were leaving the health center was held,
eliciting cooperation and collaboration. In this case, verbal in-person communication was more
effective than written communication and, hence, has been preferred for project planning and
management.
Conclusion
The practice gap identified is inadequate substance use treatment services in Little
Havana, Miami. This gap has been identified in communications with stakeholders at Banyan
Health Center in the community. The lack of services significantly determines mental health
outcomes and overdoses due to substance abuse. An inclusive and empathetic approach was used
when communicating with patients and healthcare staff. Verbal in-person discussions were the
most effective communication mode in this case and will continue to be used in the program’s
future. The PICOT question developed communicates the practice gap and the proposed
intervention to address it.
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Reference
Arnold, E. C., & Boggs, K. U. (2019). Interpersonal relationships e-book: Professional
communication skills for nurses. Elsevier Health Sciences.
Beech, B. M., Ford, C., Thorpe Jr, R. J., Bruce, M. A., & Norris, K. C. (2021). Poverty, racism,
and the public health crisis in America. Frontiers in Public Health, 9, 699049.
https://doi.org/10.3389/fpubh.2021.699049
Briseus, V., Carter-Richards, K., & Dorelien, M. (2021 Apr. 14). Financial Insecurity in MiamiDade County. https://storymaps.arcgis.com/stories/12b4058c89584f73af1857bf6688e28b
Bunn, T. L., Quesinberry, D., Jennings, T., Kizewski, A., Jackson, H., McKee, S., & Eustice, S.
(2019). Timely linkage of individuals to substance use disorder treatment: development,
implementation, and evaluation of FindHelpNowKY.org. BMC Public Health, 19(1), 114. https://doi.org/10.1186/s12889-019-6499-5
Handtke, O., Schilgen, B., & Mösko, M. (2019). Culturally competent healthcare–A scoping
review of strategies implemented in healthcare organizations and a model of culturally
competent healthcare provision. PloS One, 14(7), e0219971.
https://doi.org/10.1371/journal.pone.0219971
Smith, I., Hicks, C., & McGovern, T. (2020). Adapting Lean methods to facilitate stakeholder
engagement and co-design in healthcare. BMJ, 368. https://doi.org/10.1136/bmj.m35
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Solberg, H., & Nåden, D. (2020). It is just that people treat you like a human being: The meaning
of dignity for patients with substance use disorders. Journal of Clinical Nursing, 29(3-4),
480-491. https://doi.org/10.1111/jocn.15108
Wei, H., Corbett, R. W., Ray, J., & Wei, T. L. (2020). A culture of caring: The essence of
healthcare interprofessional collaboration. Journal of Interprofessional Care, 34(3), 324331. https://doi.org/10.1080/13561820.2019.1641476
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Synthesis of Evidence Substantiating a Practice Gap
School of Nursing and Health Sciences, Capella University
NURS-FPX8045 Doctoral Writing and Professional Practice
Dr. Peggy Soper
September, 2023
2
Synthesis of Evidence Substantiating a Practice Gap
A literature review is essential in outlining the utility of previous research in informing
quality-improvement (QI) projects. The practice gap identified in this project is the
underutilization of drug and substance treatment resources in Little Havana, Miami. The
proposed change is the implementation of Screening, Brief Intervention, and Referral to
Treatment (SBIRT) training and policy in a primary care community clinic to improve the
community’s access to and utilization of drug and substance use treatment resources. Researchers
have paid attention to the practice gap and proposed approaches in the past and conducted
studies. This paper is a critical review of the literature, a synthesis of that literature, and a
discussion of writing feedback on the project practice gap and proposed solution.
Critical Review of the Literature
The study by Bunn et al. (2019) focused on the effectiveness of a website to link people
with substance use disorders (SUD) to treatment resources. The website developed was
FindHelpNowKY.org, and the researchers aimed to develop, implement, and evaluate the
website as a platform for linking people requiring SUD treatment with appropriate resources.
Bunn et al. (2019) used a case-study qualitative research methodology to assess pre- and postintervention content, ease of use, and flow. Based on the “Strength of Recommendations Table”
(SORT) criteria, this study belongs to a level 2 rating because it is a case-control design. The
findings apply to a limited scope of patients but are generalizable to people with SUDs. Barriers
identified were lack of up-to-date information on facilities, partner lack of understanding of the
website, and lack of promotion of the website, among others. Facilitators were strategic
collaborations and support. The study is evidence of the effectiveness of web-based SUD linkage
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processes and may be adaptable to the proposed project. Knowledge of barriers and facilitators
from Bunn et al. (2019) may be transferred to planning the proposed project intervention.
Gomez et al. (2023) conducted a study on the impact of Screening, Brief Intervention,
and Referral Treatment (SBIRT) on stigmatization of SUD. The researchers in this study aimed
to determine the impact of SBIRT training on students’ and practitioners’ attitudes toward SUD
and substance-using patients. To achieve the aim, the researchers deployed quasi-experimental
quantitative research methods with pre- and post-intervention surveys of attitudes towards SUD
and substance-using patients. The SBIRT is an evidence-based theory on which this study is
based. This study is a closely controlled quasi-experimental research and can be ranked as level 1
evidence on the SORT criteria because of the controlled nature. The researchers reported a
statistically significant decline in moralistic attitudes and stereotypical behaviors among the
participants following 12 months of training on SBIRT. The findings from the Gomez et al.
(2023) study indicate the potential improvement in practitioners’ attitudes towards people
seeking SUD treatment. The findings will be transferred to the proposed project by implementing
SBIRT training.
Another study considered for this project is Cordes et al. (2022), which focuses on
knowledge and self-efficacy of SBIRT training among health and behavioral health students. The
study aimed to evaluate the effectiveness of an SBIRT student training program in enhancing
knowledge and self-efficacy in SUD screening and referral. The researchers conducted a cohort
study of the knowledge and self-efficacy changes by collecting data via surveys in pre-training
and post-training. Cordes and colleagues based the study on the SBIRT theoretical framework
for early screening, brief intervention, and referral. This study is a level 2 evidence rating on
SORT criteria because it is a case-control study with inconsistent follow-up. At post-training,
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scores of percentage knowledge increased between 1 and 7 in the student groups, and selfefficacy scores increased between 19.86 and 39.34 percent points (Cordes et al., 2022). The
researchers demonstrate the importance of training in improving knowledge and self-efficacy in
SBIRT, and these findings can be transferred to the proposed project. The proposed intervention
will include SBIRT training, as informed by findings from the study.
Moberg and Paltzer (2021) focused on the impact of SBIRT in clinics serving Medicaid
beneficiaries on SUD diagnosis and care access. The research question for the study was whether
participation in universal SBIRT was a predictor for alcohol and drug use and dependence
diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
(DSM-IV). Moberg and Paltzer (2021) used a correlational research design by comparing patient
data from a sample of patients in SBIRT and non-SBIRT clinics. The researchers based the study
on the concepts of screening and brief intervention. The evidence from this study is rated level 1
evidence due to the large scope of data, close monitoring, and controlled trial approach of the
researchers. Moberg and Paltzer (2021) study reported that patients in SBIRT clinics had 42%
greater odds of SUD diagnosis. These findings indicate the usefulness of SBIRT in improving
diagnosis and will be transferred to the current project by justifying SBIRT training for
community mental health care staff.
The last article considered for this review is the study by Martin et al. (2020), who
focused on an SBIRT training program. The researchers aimed to determine whether SBIRT
training could improve SBIRT and motivational interviewing (MI) knowledge and self-efficacy.
The target population was psychology students, and the study design was quasi-experimental.
The researchers invited students for training and later assessed students’ competence and
knowledge of SBIRT and MI. The trainers-based training on the conceptual framework of
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SBIRT and MI. Evidence from this study is highly reliable as it is level 1 evidence since it is a
controlled trial with good follow-up. Martin et al. (2020) found a statistically significant increase
in knowledge and self-efficacy of both SBIRT and MI. The study concluded that training
psychology students improves competence in using SBIRT and MI. Training approaches from
this study will be deployed in the proposed project.
Synthesis of Literature
Training healthcare staff in SBIRT will improve their knowledge, attitude, and provision
of SUD interventions and referrals for people requiring assistance. SBIRT training increases
healthcare professionals’ knowledge and self-efficacy in SUD screening and intervention (Martin
et al., 2020; Cordes et al., 2022). The evidence on knowledge and self-efficacy indicates
enhanced competence in interventions for people with SUD. Using SBIRT is also associated
with increased diagnosis of SUD (Moberg & Paltzer, 2021) and reduced stigma against
substance-using patients among providers (Gomez et al., 2023). Healthcare professionals can
assess patients in a positive light and provide adequate services. Also, it is imperative to enhance
access through channels that link care seekers with the appropriate resources (Bunn et al., 2019).
Findings from these studies are evidence of the importance and utility of SBIRT training and
facilitating access to care resources for patients with SUD. These findings support the proposed
intervention to train community health professionals and mandate SBIRT in the community
health center.
Writing Feedback
I have received great feedback on this and previous assignments, helping me develop my
writing skills. The evidence I have received is mainly on the voice I use in writing and the
organization of my ideas. I will improve my writing by practicing active voice writing in all my
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work, even outside this course. The feedback has also pointed me to essential tutorials on
organizing ideas, especially on online writing websites and Capella resources. Implementing the
feedback will move me closer to being a proficient writer who can communicate accurately and
succinctly.
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References
Bunn, T. L., Quesinberry, D., Jennings, T., Kizewski, A., Jackson, H., McKee, S., & Eustice, S.
(2019). Timely linkage of individuals to substance use disorder treatment: Development,
implementation, and evaluation of FindHelpNowKY.org. BMC Public Health, 19(1), 114. https://doi.org/10.1186/s12889-019-6499-5
Cordes, C. C., Martin, M. P., Macchi, C. R., Lindsey, A., Hamm, K., Kaplan, J., & Moreland, D.
(2022). Expanding interprofessional teams: Training future health care professionals in
screening, brief intervention, and referral to treatment (SBIRT). Families, Systems, &
Health, 40(4), 559. https://doi.org/10.1037/fsh0000755
Gomez, E., Gyger, M., Borene, S., Klein-Cox, A., Denby, R., Hunt, S., & Sida, O. (2023). Using
SBIRT (Screen, Brief Intervention, and Referral Treatment) tr
