Evidence Synthesis and Tables

Assignment

Purpose

The purpose of this assignment is to develop a synthesis of evidence using five research articles to support an evidence-based intervention.(Comprehensive Essay on Evidence Synthesis and Tables for Nursing Students)

The development of the Johns Hopkins Individual Evidence Summary Tool builds a body of research evidence about a practice problem and evidence-based intervention for implementation in a practice change project. Continually adding research studies to the Johns Hopkins Individual Evidence Summary Tool builds the foundation for the synthesis of research for a practice change project.(Comprehensive Essay on Evidence Synthesis and Tables for Nursing Students)

As you incorporate published research study findings into your own writing, you create a synthesis of the research information. Before learning how to write a synthesis, it is important to define this term. At its most basic level, a synthesis involves combining two or more summaries. Synthesis writing is more difficult than it might first appear because this combining must be done in a meaningful way.(Comprehensive Essay on Evidence Synthesis and Tables for Nursing Students)

A synthesis requires critical reading and thinking to compare different material, highlighting similarities, differences, and connections. When a practice scholar synthesizes successfully, they present new ideas based on interpretations of published research evidence. Conceptually, it can be helpful to think about synthesis existing at both the local (or paragraph) level and the global (or paper) level. Synthesis is all about collecting information from different sources and merging the information together as one content.(Comprehensive Essay on Evidence Synthesis and Tables for Nursing Students)

Please note that this week 4 assignment is the is the first part of the Week 6 assignment. You will receive feedback from your course faculty on this assignment and will be required to use the feedback to revise this paper and add as a section of the Week 6 assignment.

Instructions

Follow these guidelines when completing each component of this assignment. Contact your course faculty if you have questions.

1. Download the following tools linked below (located in the Student Resource Center under Project & Practicum Resources).
   1. Link (Word doc): Johns Hopkins Research Evidence Appraisal Tool
      

      Links to an external site.

   2. Link (Word doc): Johns Hopkins Individual Evidence Summary Tool
      

      Links to an external site.

2. Use five (5) level I, II, or III peer-reviewed primary research studies and/or systematic reviews that focus on the evidence-based intervention for the selected practice problem. Four research articles that focus on the evidence-based intervention included in this synthesis may be from previous courses. One peer-reviewed research article that focuses on the evidence-based intervention must be new to this synthesis and not used in previous courses. All articles should be current, published within the past 5 years. Enter the articles for the synthesis into the Johns Hopkins Individual Evidence Summary Tool. For new articles for this synthesis, Highlight the author’s name in the Johns Hopkins individual Evidence Summary Table.(Comprehensive Essay on Evidence Synthesis and Tables for Nursing Students)
3. Use the most current version of Microsoft Word that is the format for all Chamberlain University College of Nursing found in student resources. The Document is labeled DNP and will end in “docx.”
4. All Chamberlain University policies related to plagiarism must be observed.
5. Review the rubric for the grading criteria.

The assignment includes the following components:

1. Title Page
   1. Title of the paper
   2. Student name
   3. Chamberlain University College of Nursing
   4. Course number and course name
   5. Session month and year
2. Introduction
   1. Write a one-sentence purpose statement.
   2. Introduce the practice problem. (Cited)
   3. Introduce the evidence-based intervention using research study evidence. (Cited)
3. Describe the significance of the practice problem at the national level (1 paragraph).
   1. Significance
   2. Prevalence
   3. Mortality
   4. Economic ramifications of the practice problem. (Cited)
4. Evidence Synthesis: Using a minimum of five research articles (published within the past 5 years) to support the evidence-based intervention, write a synthesis of evidence to include the following:
   1. Include a minimum of 5 research articles to support the evidence-based intervention with citations (4 articles can be from previous courses).
   2. Identify and discuss the main themes and salient points that emerge from the sources. (Cited)
   3. Contrast the main points from evidence sources. (Cited)
   4. Present an objective overarching synthesis of research statement supporting the evidence-based intervention. (Cited)
5. Conclusion
   1. Include a summary of practice problem.
   2. Include a summary of the evidence synthesis which supports the evidence-based intervention (cite all sources).
6. Appendix: Johns Hopkins Individual Evidence Summary Table
   1. Include the Johns Hopkins Individual Evidence Summary Tool as the Appendix (With only one appendix, there is no need to label this Appendix A).
   2. Complete all sections of the Johns Hopkins Individual Evidence Summary Tool for each research study.
   3. Identify the quality and the level of evidence for all research studies.
   4. Enter the information for a minimum of 5 research articles level I, II, or III that focus on the evidence-based intervention and published within the last 5 years into the Johns Hopkins Individual Evidence Summary Table.
7. APA Standards and References
   1. Use appropriate Level I headers.
   2. Create the reference page.
   3. Each reference has a matching citation and citations are in current APA style.

Writing Requirements (APA format)

• Length: 3-4 pages (not including title page, reference page, and appendix)
• 1-inch margins
• Double-spaced pages
• 12-point Times New Roman font or 11-point Arial
• Headings & subheadings
• In-text citations
• Title page
• References page
• Appendix
• Standard English usage and mechanics

Course Outcomes

This assignment enables the student to meet the following course outcomes:

1. Develop strategies to lead project planning, implementation, management, and evaluation to promote high value healthcare. (POs 3, 5, 7)

Comprehensive Essay on Evidence Synthesis and Tables for Nursing Students

Purposed statement

This paper aims to develop an evidence synthesis on motivational interviewing supported by technology as an evidence-based intervention for medication nonadherence.(Comprehensive Essay on Evidence Synthesis and Tables for Nursing Students)

Practice Problem

The practice problem that this DNP project seeks to solve is treatment nonadherence among Schizophrenia patients. The majority of literature documents a high prevalence of nonadherence among patients diagnosed with Schizophrenia taking antipsychotic medication. A recent narrative review showed that Schizophrenia patients remain uninformed about medication, yet they value talks related to medications provided by healthcare professionals (Salzmann-Erikson & Sjödin, 2018). Remaining uninformed about medication is a significant barrier to treatment adherence, and practitioners are encouraged to adopt mechanisms to involve patients in their care.(Comprehensive Essay on Evidence Synthesis and Tables for Nursing Students)

Evidence-Base Intervention (EBI)

The proposed intervention involves implementing technology with motivational interviewing (MI). Motivational interviewing will utilize OAR Model skills of open-ended questions, affirmations, reflective listening, and summary periods. MI is a long-standing EBI that primarily guides individuals to implement some changes (Mullen et al., 2020). MI utilizes the four principles of EDRS: expressing sympathy, developing discrepancy, rolling with client resistance, and supporting self-efficacy. In this regard, MI is considered direct and patient-centered counseling to help patients identify and resolve their ambivalent selves.(Comprehensive Essay on Evidence Synthesis and Tables for Nursing Students)

National Context

Nonadherence is a serious problem that affects patients and the healthcare system globally and in the United States. Globally, the rate of nonadherence to Schizophrenia treatment is 50% (Viveiros et al., 2020). Conversely, between 26.5% and 58.8% of patients diagnosed with Schizophrenia report nonadherence (Salzmann-Erikson & Sjödin, 2018). Nonadherence to the associated psychotic relapse, worsening of the disease, mortality, increased suicide risk, hospital readmission, and increased healthcare costs. The cost of nonadherence for schizophrenia medication with reference to the impact on health, resources, and costs is estimated at $116434 (Cutler et al., 2018).(Comprehensive Essay on Evidence Synthesis and Tables for Nursing Students)

Evidence Synthesis

            Researchers have used motivational interviewing as an EBI for various clinical issues, including medication adherence. Zomahoun et al. (2017) evaluated the efficacy of MI on medication adherence among adults diagnosed with chronic illnesses. The study found that MI interventions successfully promote medication adherence in adults diagnosed with chronic diseases, including Schizophrenia. Harmaci & Budak (2022) assessed the effect of psychoeducation through motivational interviewing on medication adherence, psychological/psychosocial well-being, and a sense of hope among schizophrenia patients. The findings showed that using motivational interviewing techniques to provide psychoeducation effectively promotes medication adherence.(Comprehensive Essay on Evidence Synthesis and Tables for Nursing Students)

Dobber et al. (2018) evaluated the interactions of MI among Schizophrenia patients. The study identified aspects of MI such as trusting relationships, integration of patients’ values, ability to adapt Motivational interviewing to patients’ situations, and their association with improved medication adherence among schizophrenia patients. Ertem & Duman (2019) assessed the effect of MI on insight levels and treatment adherence among schizophrenia patients. The findings showed improved medication adherence with MI. Chien et al. (2019) assessed the impact of adherence therapy through motivational interviewing among schizophrenia patients. The study findings revealed the cost-effectiveness of MI for medication adherence among schizophrenia patients, reduced rehospitalization, and positive psychosocial outcomes. The central theme highlighted across the studies is the positive role of MI on medication nonadherence. However, the different studies highlight the additional impact of MI on treatment-related factors such as patient insight, psychological/psychosocial well-being, and reduced rehospitalization.

Conclusion

The practice problem that this DNP project seeks to solve is treatment nonadherence among Schizophrenia patients. Most of the literature documents a high prevalence of nonadherence to medication among Schizophrenia patients taking antipsychotic medication (Salzmann-Erikson & Sjödin, 2018). Existing literature supports the effectiveness of MI on medication adherence and associated benefits, including psychosocial well-being, reduced rehospitalization, and insight (Zomahoun et al., 2017; Harmaci & Budak, 2022; Ertem & Duman, 2019; Chien et al., 2019). Therefore, the present hypothesizes enhanced medication adherence among participants.(Comprehensive Essay on Evidence Synthesis and Tables for Nursing Students)

References

Chien, W. T., Cheung, E. F., Mui, J. H., Gray, R., & Ip, G. (2019). Adherence therapy for Schizophrenia: A randomized controlled trial. Hong Kong Med J, 25(Suppl 2), 4-9. https://pubmed.ncbi.nlm.nih.gov/30674700/(Comprehensive Essay on Evidence Synthesis and Tables for Nursing Students)

Cutler, R. L., Fernandez-Llimos, F., Frommer, M., Benrimoj, C., & Garcia-Cardenas, V. (2018). Economic impact of medication nonadherence by disease groups: a systematic review. BMJ open, 8(1), e016982. https://doi.org/10.1136%2Fbmjopen-2017-016982

Dobber, J., Latour, C., de Haan, L., Scholte op Reimer, W., Peters, R., Barkhof, E., & van Meijel, B. (2018). Medication adherence in patients with Schizophrenia: a qualitative study of the patient process in motivational interviewing. BMC Psychiatry, 18(1), 1-10. https://doi.org/10.1186/s12888-018-1724-9

Ertem, M. Y., & Duman, Z. Ç. (2019). The effect of motivational interviews on treatment adherence and insight levels of patients with Schizophrenia: A randomized controlled study. Perspectives in psychiatric care, 55(1), 75-86. https://doi.org/10.1111/ppc.12301

Harmanci, P., & Budak, F. K. (2022). The Effect of Psychoeducation Based on Motivational Interview Techniques on Medication Adherence, Hope, and Psychological Well-Being in Schizophrenia Patients. Clinical Nursing Research, 31(2), 202-216. https://doi.org/10.1177/10547738211046438

Mullen, A., Isobel, S., Flanagan, K., Key, K., Dunbar, A., Bell, A., & Lewin, T. J. (2020). Motivational interviewing: Reconciling recovery-focused care and mental health nursing practice. Issues in Mental Health Nursing, 41(9), 807-814. https://doi.org/10.1080/01612840.2020.1731891

Salzmann-Erikson, M., & Sjödin, M. (2018). A narrative meta-synthesis of how people with schizophrenia experience facilitators and barriers in using antipsychotic medication: Implications for healthcare professionals. International Journal of Nursing Studies, 85, 7-18. https://doi.org/10.1016/j.ijnurstu.2018.05.003

Viveiros, C. P., Tatar, C. R., Dos Santos, D. V. D., Stefanello, S., & Nisihara, R. (2020). Evaluation of nonadherence to treatment among patients with Schizophrenia attending psychosocial care centers in the south region of Brazil. Trends in psychiatry and psychotherapy, 42, 223-229. https://doi.org/10.1590%2F2237-6089-2019-0072

Zomahoun, H. T. V., Guenette, L., Gregoire, J. P., Lauzier, S., Lawani, A. M., Ferdynus, C., … & Moisan, J. (2017). Effectiveness of motivational interviewing interventions on medication adherence in adults with chronic diseases: a systematic review and meta-analysis. International Journal of Epidemiology, 46(2), 589-602. https://doi.org/10.1093/ije/dyw273.

Practice Question: For adults with a history of Schizophrenia in the inpatient setting, does implement technology with motivational interviewing (MI), compared with current practice, impact medication nonadherence in 8-10 weeks?

Date:

Article Number	Author and Date	Evidence Type	Sample, Sample Size, Setting	Findings That Help Answer the EBP Question	Observable Measures	Limitations	Evidence Level, Quality
46(2):589-602	Zomahoun et al. 1 Apr 2017	Systematic review and meta-analysis of RCTs	16 RCTs	MI enhanced medication adherence	·  Medication adherence	·  Limited effectiveness of MI	A/B High/Good Quality
31(2): 202-216	Harmaci & Budak 31 Feb 2022	RCT (Pretest-posttest control group design)	Schizophrenia patients n=150	Enhanced medication adherence, hope, and psychological well-being levels.	·   Medication adherence ·   Hope ·   Psychological well-being	·  High drop-outs	Level I, High Quality
18(1):135	Dobber et al.18 May 2018	Qualitative multiple case study based on RCTs	Schizophrenia patients N=55	Enhanced medication adherence	·   Medication adherence	·   MI therapists are not expert ·   Limited sample size	Level I, High Quality
55(1):75-86.	Ertem & Duman Jan 2019	Randomized Controlled Trial	Schizophrenia patients N=40 Dokuz Eylül University, outpatient clinic	Enhanced medication adherence	·   Medication adherence ·   Medication insight	·   Poor internal consistency of Morisky’s Questions-Self-Report Measure of Adherence ·   Limited sample	Level I, High Quality
2(1):4-9.	Chien et al. Feb 2019	Randomized Controlled Trial	None adherent schizophrenia patients n=67 community psychiatric nursing services centers; New Territories West and Kowloon West	Adherence therapy based on MI improved poor medication adherence among schizophrenia patients.	·   Insight and Treatment Attitudes ·   Medication adherence ·   Level of functioning ·   Re-hospitalization ·   Positive and negative symptoms	Small and selective sample Participants were nonblinded Impact of cofounding factors on medication not controlled	Level I, High Quality