Write a response to this discussion post about 300 words. There is two discussion post to write about. Thank you

Here is the first discussion post.

1. By now you should realize that research is ongoing and there is often new or more information available. We realize you developed a PICOT question in MSN 600 and did part of this assignment. Now it is time to take it to another step and look at your subject deeper. If you liked your question, you may use it again here. It is now time to improve your question, do so now. If you do not like your question, start afresh. Researchers typically modify their research question many times before they finalize it. Choose a problem or issue that you anticipate within your future advanced nursing role. Describe this problem in 5 sentences or less. You will be able to use it in the next assignment and in future courses.

A problem I anticipate seeing as a PHMNP in the future is substance abuse. Substance abuse is defined by Merriam Webster Dictionary as “excessive use of a drug (such as alcohol, narcotics, or cocaine): use of a drug without medical justification”. Drugs can be prescribed or illicit. Approximately 49,000 Americans died from overdoses in 2017. It is a global family and public health epidemic taking a huge financial and emotional toll on society. Many substance abusers have underlying comorbid psychiatric conditions (Hunt et al.,2019).

Formulate your question using the PICOT format. For those of you in clinical concentrations (NPs), your question needs to be a clinical question. The NEL and NED students may develop a question within their concentration’s focus. This question will drive the literature search for your issue.

Does Cognitive Behavioral Therapy improve outcomes for substance abusers who are also taking medication compared to substance abusers who are using medication and usual therapy at short term and long term follow up?

1. To support and assist in choosing and writing your PICOT in question 1 of this discussion board, you should have reviewed a minimum of 6-10 articles with at least one being a quantitative design. List the 6-10 articles here as a response to this #3 question. The articles should be in alphabetical order and each article should be listed as a full citation using the APA format.

REFERENCES

Hunt, G. E., Malhi, G. S., Lai, H. M. X., & Cleary, M. (2020). Prevalence of comorbid substance use in major depressive disorder in community and clinical settings, 1990–2019: Systematic review and meta-analysis. Journal of Affective Disorders, 266, 288–304. https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1016/j.jad.2020.01.141 (Links to an external site.) (Links to an external site.)

Klemperer, E. M., Hughes, J. R., & Naud, S. (2018). Study characteristics influence the efficacy of substance abuse treatments: A meta-analysis of medications for alcohol use disorder. Drug and Alcohol Dependence, 190, 229–234. https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1016/j.drugalcdep.2018.06.015 (Links to an external site.) (Links to an external site.)

McCabe, E., & Parrish, M. (2018). A review of the complexities of working effectively with people being prescribed both antipsychotic medications and opioid substitution therapy. Drugs: Education, Prevention & Policy, 25(1), 1–12. https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1080/09687637.2016.127798 (Links to an external site.) (Links to an external site.)

McHugh, R. K., & Weiss, R. D. (2019). Alcohol Use Disorder and Depressive Disorders. Alcohol Research: Current Reviews, 40(1), 3–10. https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.35946/arcr.v40.1.01 (Links to an external site.) (Links to an external site.)

Mojtabai, R., Barry, C., & Olfson, M. (2019). Medication And Substance Abuse: The Authors Reply. Health Affairs (Project Hope), 38(4), 695. https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1377/hlthaff.2019.00168 (Links to an external site.) (Links to an external site.)

Oliva, E. M., Maisel, N. C., Gordon, A. J., & Harris, A. H. (2011). Barriers to use of pharmacotherapy for addiction disorders and how to overcome them. Current psychiatry reports, 13(5), 374–381. https://doi.org/10.1007/s11920-011-0222-2

Ray, L. A., Meredith, L. R., Kiluk, B. D., Walthers, J., Carroll, K. M., & Magill, M. (2020). Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis. JAMA Network Open, 3(6), e208279. https://doi-org.northernkentuckyuniversity.idm.ocl…

Robinson, S. M., & Adinoff, B. (2018). The mixed message behind “Medication-Assisted Treatment” for substance use disorder. American Journal of Drug & Alcohol Abuse, 44(2), 147–150. https://doi-org.northernkentuckyuniversity.idm.ocl…

Choose one of those articles cited in #3 above that is a quantitativearticle and use Polit and Beck (2020), Box 4.3 – Guidelines for Critically Appraising Research Problems, Research Questions, and Hypotheses on page 65. Answer each of the 8 questions and discuss the relationship of this article to your PICOT.

Ray, L. A., Meredith, L. R., Kiluk, B. D., Walthers, J., Carroll, K. M., & Magill, M. (2020). Combined Pharmacotherapy and Cognitive Behavioral Therapy for 1.Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis. JAMA Network Open, 3(6), e208279. https://doi-org.northernkentuckyuniversity.idm.ocl…

What is the research problem? Is the problem statement easy to locate and is it clearly stated? Does the problem statement build a cogent and persuasive argument for the new study?

The study included the research problem in the beginning under key points. The question stated was “Is cognitive behavioral therapy associated with improved outcomes for alcohol and other substance abuse disorders in the context of pharmacotherapy for addiction?” (Ray et al.,2020). The Introduction section included several paragraphs eliciting research and evidence that very few meta-analyses have been done on this particular intervention approach, meaning not studies on the combination of pharmacotherapy and CBT. Pharmacotherapy and CBT are first line interventions for substance abuse and co-diagnoses that come along with SAD (Mchugh & Weiss, 2019). But what do we know about combinations? This is a very persuasive approach and argument for this study.

Does the problem have significance for nursing? How might the research contribute to nursing practice, administration, education or policy?

Substance abuse is a very significant problem for nursing. Psychiatric nurses specialize in patients with SAD, and nurses in most specialties will encounter patients with SAD, even if that is not the primary diagnosis. The research can provide evidence-based practices for guiding patients with SADs to treatment that is most likely to lead to positive outcomes. If studies can show significant changes in response to a specific intervention combination, this could spark funding and policy for CBT and pharmacological therapy access.

Is there a good fit between the research problem and the paradigm in which the research was conducted? Is there a good fit between the problem and the qualitative research tradition?

This quantitative study was a meta-analysis. A meta-analysis is a statistical analysis combining results of multiple scientific studies addressing the same issue (Polit & Beck,2021). This paradigm is appropriate as both CBT and pharmacotherapy have been used and studied for SUD for over 25 years. The publication range included studies from 1992 to 2016.

Does the report formally present a statement of purpose, research question, and/or hypotheses/? Is this information communicated clearly and concisely and isi it placed in a logical and useful location?

As stated previously, the “question” section under key points included the problem. In the first heading of the abstract, the authors assert under the heading “importance” that SUD is a pressing health concern for the public and an understanding of the effects of different combinations of treatments can help to lessen the burden by improving outcomes and sobriety.

Are purpose statements or questions worded appropriately? For example, are key concepts/variables identified and is the populations of interest specified? Are verbs used appropriately to suggest the nature of the inquiry and or research tradition?

The heading “Objective” in the Abstract is very clear on the data to be extrapolated from multiple studies, and that is to conduct a meta-analysis of the published literature on combined CBT and pharmacotherapy for SUDs. The Introduction states the goal of the study is a comprehensive review of 3 distinct subgroups. The first subgroup are CBT plus pharmacotherapy compared with “usual” care and pharmacotherapy. The second group is CBT and pharmacotherapy compared to a specific therapy with pharmacotherapy. Last is CBT added to usual care and pharmacotherapy compared with usual care and pharmacotherapy alone. Verbiage is appropriate.

If there are no formal hypotheses, is their absence justified?

There is a formal hypothesis as stated. The question is asking if CBT is associated with improved outcomes for SUD in context of pharmacotherapy for addiction.

Do hypotheses flow from a theory of previous research? Is there a justifiable basis for the predictions?

CBT is evidence based first line treatment for many mental health issues, including substance abuse and has been well documented for years as such ( Klemperer et al.,2018). Pharmacotherapy is also a widely embraced intervention for SUD (Klemperer et al., 2018). The hypotheses that the combination would improve outcomes is justifiable.

.Are hypotheses worded properly? Do they state a predicted relationship between two or more variables ? Are they directional or nondirectional, and is there a rationale for how they were stated? Were they presented as research or null hypotheses ?

The hypothesis was stated nondirectionally. The question did not predict that outcomes would be improved or not, just asked the question what combination if any improve outcomes. The sample came from 30 unique randomized clinical trials that examined CBT in combination with some form of pharmacotherapy. The hypothesis was a research hypothesis. In summary, this article contained the targeted population and intervention. The article comprehensively compared CBT with pharmacological therapy against usual methods and other evidence-based methods of therapy.

Hello, this is the second discussion post to write a respond.

• Collapse SubdiscussionCarola Sinquefield

  Carola Sinquefield

  YesterdayNov 20 at 10:13pmManage Discussion Entry

  Hi Tabitha, I enjoyed reading your discussion board post. I agree that patients often have a negative view of the care provided by nurse practitioners and are quick to demand to see a doctor without giving the nurse practitioner a chance. However, I was able to find a study based in Canada that indicates a different point of view of nurse practitioners. Rickards et al. (2020) sought to investigate the relationship between patients experiences and the care provided by nurse practitioners. Even though, in the New Brunswick providence, care by nurse practitioners was not introduced until 2002, patients report experiencing great care provided by nurse practitioners (Rickards et al., 2020). Patients in this study go on to point out that nurse practitioners provide the same quality care as primary care doctors, often exceeding the quality of care provided by primary care doctors (Rickards et al., 2020). According to patients, nurse practitioners often were easier to access than primary care doctors, had better communication skills, and focused more on establishing a relationship with the patient (Rickards et al., 2020) This study has implications to help guide future nursing practice for nurse practitioners as the push for more nurse practitioners will only continue to rise. This gives hope that patients, in the future, will see the benefits of nurse practitioners and be more likely to seek out their care.