Manuscript Part 2: Literature Synthesis, and Evidence-Based Intervention

Purpose

The purpose of this assignment is to write the second part of the DNP Project Manuscript. This assignment will allow you to present your introduction, background, practice question, literature synthesis, and evidence-based intervention. These project design sections will be added to the DNP Project Manuscript Part 1 assignment. Turnitin will be applied to this assignment.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students

Instructions

Start with the week 2 paper and the feedback from your faculty. Ensure that all track changes are accepted and make all of the revisions that your faculty requested for the week 2 assignment. Students are required to make all requested revisions per your faculty feedback and Submit a Clean Copy of the week 4 paper. Add the evidence-based intervention and literature synthesis sections (Parts 1-4) to complete the Week 4 Assignment.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

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

1.  Part 2 will be graded on the quality of information, use of current research, Standard English usage and mechanics, APA format, and overall organization based on the required components as summarized in the guidelines and grading criteria/rubric.

2.  Review the grading rubric carefully and consider how to incorporate each required criterion into Part 2 of the DNP Project Manuscript Template.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

3.  Review the tutorial on the use of the DNP Project Manuscript Template in the Week 2 lesson.

Follow the instructions on the template for the literature synthesis, and evidence-based intervention. Submit Part 2 of the DNP Project Manuscript.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

1.  Revise the Week 2 assignment accepting the Track Changes and make the other revisions to your assignment that your faculty requested.  

2.  Research Synthesis and Evidence-Based Intervention (4 Parts)

a.      Part 1: The Johns Hopkins Individual Evidence Summary Tool

                                                                    i.Before writing the synthesis, complete the Johns Hopkins Individual Evidence Summary Tool. Enter a minimum of 10 (or more) research articles supporting the evidence-based intervention in the table, entering the correct information in each column (Appendix A in the DNP Project Manuscript Template). The completed John Hopkins Individual Evidence Summary Table should be located in Appendix A in the DNP Project Manuscript Template. You may use research articles focusing on the intervention from NR730 and other previous courses. Submit the completed John Hopkins Individual Evidence Summary Table with this assignment in Appendix A.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

1.      Complete the Johns Hopkins Individual Evidence Summary Tool.

2.      Enter 10 or more research articles supporting the evidence-based intervention. 

3.      The correct information is entered in each column.  

4.      Submit the Johns Hopkins Individual Summary Tool in Appendix A in the DNP Project Manuscript Template.

5.      Use the Johns Hopkins Research Appraisal tool and the Johns Hopkins Evidence Level and Quality Tool to determine the level and quality of the research Articles for the last column in the Johns Hopkins Individual Evidence Summary Table.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

b.      Part 2: Brief Description of Intervention and Endorsement

                                                                    i.In the DNP Project Manuscript Template, begin this paragraph under the Level 2 Header:  Evidence-Based Intervention. 

                                                                  ii.Begin this section with the name and brief description of the evidence-based intervention.

                                                                 iii.Identify the national organization or government agency that endorses the intervention, if applicable.

c.       Part 3: Process, Outcome, and Themes of Research Evidence(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

                                                                    i.In the DNP Project Manuscript Template, begin this paragraph under the Level 2 Header:  Evidence-Based Intervention. 

                                                                  ii.Start the synthesis section with a statement of how many articles are included, and all articles should support the intervention is effective in changing your selected project outcome and related to the population for your project.

1.      The synthesis section must include at least 10 articles supporting the intervention.

2.      The articles must be 5 years old or less.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

3.      The sources should be evidence-based, peer-reviewed research articles. 

4.      The synthesis may include both quantitative and qualitative research studies and national standards or guidelines.

                                                                 iii.In a brief summary statement, provide the numbers of research articles that are level I, II, and III and give a summary of the quality of the research articles.

                                                                iv.Start each theme with a Level 3 Header as formatted in the DNP Project Manuscript Template.  Each theme must have its own header as indicated in the DNP Project Manuscript Template.  

                                                                  v.Identify the main themes that emerge from the sources in the level 3 headers and in the paragraph under each header, describe how the intervention was used in the research to solve the practice problem or outcome(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

1.      Please Note: This is not an article-by-article review and is not an annotated Bibliography. The synthesis is a separate writing method in which the themes are identified in the research articles and each theme is discussed and the research articles supporting that themes are cited. (Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

                                                                vi.Explain the differences (contrast the main points) in the research articles. In the DNP Project Manuscript Template, begin this paragraph under the Level 2 Header:   Contrasting Results or Themes in the Research.

                                                              vii.Present an objective overarching synthesis of research statement supporting the evidence-based intervention.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

d.      Part 4: Detailed Sequence of Intervention

                                                                    i.Provide an in-depth and exact explanation of the evidence-based intervention you will implement. Describe the intervention exactly as the intervention was implemented in the research articles and include the specific key details.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

                                                                  ii.Use the research articles to create a detailed discussion describing each of the steps in the intervention implementation. The evidence-based intervention should be implemented as described in the research, with all the original authors’ intended components.

                                                                 iii.Describe in detail how each participant will engage with the intervention from beginning to end of the intervention. This should be so detailed that someone else who has never heard of your project can pick up your intervention description and implement this exactly as you described.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

3.  References

a.      Information in this manuscript must be substantiated by citations.

b.      Reference publication dates must be within the last 5 years.  (Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

c.       References must be from peer-reviewed journals, government websites, and credible national and global organizations.

d.      In-text citations should align with the reference page. 

e.      In-text citations and references must be in the current APA format. 

4.  Scholarly Writing Criteria 

a.      Submit the paper on the DNP Project Manuscript Template.

b.      Use the headers provided in the template.

c.       Use the current APA style and format throughout the manuscript.

d.      Use the Chamberlain Guidelines for Writing a Professional Paper (located in Student Resources) to complete this assignment.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

e.      Turn on Grammarly to check the grammar, sentence structure, and punctuation as you write. (Note: if you have not already done so, please download the free version at Grammarly.com before construction of the assignment.)

f.        Use third person in this DNP Project Manuscript. However, per APA, you can use first person in the project management section when you are talking about what you will do during implementation.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Note: Make sure to include the edited Part 1 manuscript items.

Writing Requirements (APA format)

·     Length: 3-5 pages (not including title page, references page and Part 1)

·     1-inch margins

·     Double-spaced pages

·     12-point Times New Roman font or 11-point Arial

·     Headings & subheadings(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

·     In-text citations

·     Title page

·     References page (without permalinks)

·     Standard English usage and mechanics

·     Organized presentation of ideas

Course Outcomes

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

1.  Synthesize scientific knowledge, theory, and practice expertise to inform evidence-based practice and impact outcomes. (POs 1, 3, 4, 5, 6, 9)(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

2.  Design an evidence-based translational science project to address a practice problem. (POs 1, 2, 3, 4, 5, 6, 7, 8, 9)

3.  Apply effective strategies in project design for managing practice problems in healthcare delivery at the micro, meso, and macro-system levels. (POs 1, 2, 3, 4, 5, 6, 7, 8, 9)(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

4.  Demonstrate project management and leadership skills in the design process for the evidence-based translational science project. (POs 1, 2, 5, 6, 7, 8, 9)

5.  Create collaborative relationships with interprofessional and intraprofessional groups to champion organizational improvements through project design. (POs 2, 4, 6, 8)

Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students

Introduction

Schizophrenia is a mental disorder that impairs thought processes and patterns, perceptions, emotional responses, and social interactions (NIMH, n.d.). Schizophrenia is persistent and can be severe and disabling when symptoms are not adequately managed (NIMH, n.d.). This DNP project pursues a nurse-led intervention to improve medication adherence and symptom management. Mucci et al. (2020) recommend a person-centered approach to healthcare that encompasses building therapeutic relationships between providers and patients and collaboration between providers when working with schizophrenia patients to achieve compliance. The project aims to evaluate the impact of technology with motivational interviewing on medication adherence among inpatient schizophrenia patients. This paper offers a literature synthesis of motivational interviewing effectiveness in enhancing medication adherence among schizophrenia patients. (Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students

Part 2: Brief Description of Intervention and Endorsement

Evidence-Based Intervention

Motivational Interviewing (MI) is adopted as an evidence-based intervention to encourage behavioral change. MI is a collaborative, goal-oriented communication approach that focuses on the language of change to help people bolster personal or intrinsic motivation for and commitment to a particular objective by considering the individual’s need for change in an accepting and compassionate atmosphere. MI guides communication, balancing good listening and offering information and advice to empower individuals to change by eliciting their personal meaning, need and capacity for change. It is founded on a respectful and curious approach to interacting with people to promote a natural change process while honoring the patient’s autonomy. MI is primarily used for patients who are unwilling or ambivalent to change, combining different evidence-based interventions from cognitive and social psychology. It assumes that individuals with problematic attitudes and behaviors have varying readiness for change levels. Not recognizing the ambivalence would lead to patients rendering well-intentioned medical advice as threatening their autonomy and freedom of choice, increasing their will to exercise their freedom to make choices, which increases non-adherence. This paper adopts MI as an evidence-based intervention to increase personal motivation for and committed attitudes and behaviors to help schizophrenia patients find their own meaning and need for change in an accepting and empathetic atmosphere, aiming to improve medication adherence. The Motivation Interviewing Network of Trainers (MINT) endorses this intervention as an approach to encourage behavioral change.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Part 3: Process, Outcome, and Themes of Research Evidence

Evidence-Based Intervention

Ten articles fit the inclusion criteria, which required articles to be 5 years old or less, evidence-based, peer-reviewed, and demonstrate the efficacy of the chosen intervention, i.e., technology with motivational interviewing (MI) in improving medication adherence. Both qualitative and quantitative studies supporting the intervention were selected for this paper. The ten articles selected for review include Dobber et al. (2018), Dobber et al. (2020), Harmacnci and Budak (2022), Zomahoun et al. (2017), Pupus et al. (2022), Palacio et al. (2019), Hogan et al. (2020), Aubeeluck et al. (2021), Khadoura et al. (2021), and Abughosh et al. (2019). (Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Of the selected articles, six were level I, one was level II, and three were level III. The types of evidence included in level I evidence are clustered randomized controlled trials, experimental studies, and systematic reviews of RCT with or without meta-analysis. Types of evidence in level II evidence is a prospective study. In level III evidence, a qualitative multiple case study, mixed method study, and secondary analysis of data were included. All studies were high quality, with consistent, generalizable findings, a sufficient sample size for the respective designs and study purpose, adequate control, definitive conclusions, and pervasive recommendations based on the results.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Main Themes

Success Factors influencing MI Positive Effects

According to Dobber et al. (2018), trusting relationships between patients and therapists, the therapist’s ability to adopt or tailor MI strategy to a patient’s issues, and incorporating the patient’s values, needs, and perceptions of long-term medication adherence can increase MI-intervention success for medication adherence in schizophrenia patients. Dobber et al. (2020) established that a trusting relationship and empathy could help trigger mechanisms of change and enhance medication adherence. MI sessions were organized for 14 schizophrenia patients with a history of medication non-adherence. In the sessions, the patients demonstrated their medication cognitions, which were used to determine ambivalence patterns among the patient and identify success factors for MI’s positive effects. These studies established a trusting relationship between a client and the therapist, the therapist’s ability to adopt or tailor MI strategy to a patient’s issues, and incorporating the patient’s values, needs, perceptions to long-term medication adherence, and empathy as the success factors that influenced positive effects of MI. (Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)  

Association between MI Techniques and Medication Adherence

Various MI techniques are identified across the studies, including telephonic MI, fidelity-based feedback, face-to-face MI, MI-consistent (MICO) method, and MI-techniques-based psychoeducation. Palacio et al. (2019) established that telephonic MI and fidelity-based feedback were significantly linked to medication adherence. According to Hogan et al. (2020), MI-consistent (MICO) method was positively associated with change and sustain talk. Abughosh et al. (2019) found that MI-based telephone intervention is promising in improving medication adherence. Patients who completed the initial call and at least 2 follow up calls were more likely to be adherent. Harmanci and Budak (2022) established that MI-techniques-based psychoeducation significantly enhanced medication adherence, hope and psychological well-being for patients in the experimental group.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

MI Impact on Medication Adherence

Most studies explored MI in general and its effects on medication adherence without a focus on a specific MI technique or approach. According to Papus et al. (2022), MI improved medication adherence in 23 RCTs and risky behaviors and disease symptoms in 19 RCTs. Zomahoun (2018) established that MI interventions might be helpful in improving medication adherence for chronic conditions in adults. Per Aubeeluck et al. (2021), MI interventions significantly improved medication adherence in 5 RCTs and systolic blood pressure in 1 RCT. Khadoura et al. (2021) found that MI significantly improved medication adherence, self-efficacy, and intrinsic motivation for patients in the intervention group.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Contrasting Results or Themes in the Research

Palacio et al. (2019) established that telephonic MI was significantly linked to medication adherence. Abughosh et al. (2019) found that MI-based telephone intervention is promising in improving medication adherence. Both studies indicate telephonic MI is effective in enhancing medication adherence. However, Palacio et al. (2019) found varying effects across various categorical measures, implying that telephonic MI impacted different groups or measures differently. Abughosh et al. (2019) findings across all patient groups were consistent, indicating better results for those who received two or more calls. The studies also focus on varying themes. Dobber et al. (2018) and Dobber et al. (2020) address the success factors influencing MI’s positive effects. Palacio et al. (2019), Abughosh et al. (2019), Hogan et al. (2020), and Harmanci and Budak (2022) address specific MI techniques adopted to address medication adherence, including telephonic MI, fidelity-based feedback, face-to-face MI, MI-consistent (MICO) method, and MI-techniques-based psychoeducation. Papus et al. (2022), Zomahoun (2018), Aubeeluck et al. (2021), and Khadoura et al. (2021) address MI in general and its effectiveness in improving medication adherence. Other than the contrasting effects and themes of MI across the studies and for different disease conditions and patient populations, the studies’ results were consistent, indicating MI and MI techniques as effective in enhancing medication adherence.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Objective Overarching Synthesis of Research Statement Supporting the Evidence-Based Intervention

MI was selected because of its adaptability to many different settings (Pupus et al., 2022). Moreover, MI has significantly impacted medication adherence (Dobber et al., 2018; Dobber et al., 2020; Harmacnci and Budak, 2022; Zomahoun et al., 2017; Pupus et al., 2022; Palacio et al., 2019; Hogan et al., 2020; Aubeeluck et al., 2021; Khadoura et al., 2021; Abughosh et al., 2019). MI is also associated with various mental health outcomes that promote medication adherence, such as hope and mental well-being (Harmacnci & Budak, 2022). These aspects of MI suggest that the intervention is evidence-based and can help mitigate medication non-adherence among schizophrenia patients in an inpatient facility.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Part 4: Detailed Sequence of Intervention

Explanation of the Evidence-Based Intervention

Across the research studies, MI is adopted as an evidence-based, collaborative tool for improving medication adherence. The studies acknowledge MI focus on patient ambivalence and lack of the individual’s own motivation and commitment to change. MI across the studies address the common patient’s problem of ambivalence regarding medication adherence. Patients are aware of the positive effects of medication, such as preventing psychotic relapse and readmission but are burdened by the side effects and the need to take medication as prescribed. The therapist is at the center of implementing MI in healthcare organizations and is deliberately influencing patients’ motivation for change by adopting strategies such as change talk elicitation, sustain talk, developing trusting relationships with patients, adopting empathetic attitudes, communicating partnerships with patients and intervening through the four overlapping processes of MI, including engaging or relation building, focusing or identifying a patient’s change, evoking or eliciting change talk and client’s need for change, and planning or helping the patient create a comprehensive change plan. The therapists have also been integral across studies in implementing MI techniques such as telephonic MI, calling and communicating o the patients, fidelity-based feedback, face-to-face MI, MI-consistent (MICO) method, and MI-techniques-based psychoeducation. Generally, the studies consider the therapist as imperative in the process of implementing MI and the patient and patient perspectives as the drivers of MI.  (Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students) 

Steps in the Intervention Implementation

Across the research studies, MI and MI techniques have been adopted using the four processes of MI: engaging, focusing, evoking, and planning. The first process, engaging, allows the therapist to develop a good trusting and working relationship with the client to understand the problem. This process requires reflective listening to understand the client and the ambivalent attitude. The second process is focusing, which involves identifying a clear objective and goal, including identifying target behavior, exploring ambivalence and barriers, and establishing discrepancy. For this paper, the target behavior is medication adherence. The evoking process requires a practitioner to focus on and help the client towards the target goal or behavior. The therapist tries to evoke the client’s own internal motivation and needs for change and reinforce the overall motivation for change. This process involves the change talk that involves evoking desire and motivation for change and mobilizing commitment to change. It also entails the sustain talk, which is about ensuring the target behavior is sustained over time. In the planning face, the therapist strives to establish a commitment to change and develop an action plan, including considering outside support, developing skills, and removing barriers.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Participant Engagement during Intervention Implementation

Motivational interviewing is more patient-centered, promoting the patient’s autonomy during the elicitation of motivation and need for change and commitment to change. The practitioner will engage patient perspectives through the implementation and the MI processes to ensure continuous patient engagement. Practitioners involved will continuously ask questions, reinforce responses using affirmations, and adopt a lot of reflective listening to ensure the patients feel heard and engaged, encouraging their involvement through the intervention implementation. A good and trusting relationship will precede every activity to establish good engagement before beginning the change conversation. The therapists will use the guiding style to engage participants, clarify strengths, motivation and need for change, and foster autonomy in decision-making to ensure full involvement throughout the implementation.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

References

Abughosh, S., Wang, X., Serna, O., Esse, T., Mann, A., Masilamani, S., Holstad, M. M., Essien, E. J., & Fleming, M. (2019). A Motivational Interviewing Intervention by Pharmacy Students to Improve Medication Adherence. Journal of managed care & specialty pharmacy23(5), 549–560. https://doi.org/10.18553/jmcp.2019.23.5.549(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Aubeeluck, E., Al-Arkee, S., Finlay, K., & Jalal, Z. (2021). The impact of pharmacy care and motivational interviewing on improving medication adherence in patients with cardiovascular diseases: A systematic review of randomised controlled trials. International journal of clinical practice75(11), e14457. https://doi.org/10.1111/ijcp.14457(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

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

Dobber, J., Latour, C., van Meijel, B., Ter Riet, G., Barkhof, E., Peters, R., … & de Haan, L. (2020). Active ingredients and mechanisms of change in motivational interviewing for medication adherence. A mixed methods study of patient-therapist interaction in patients with schizophrenia. Frontiers in psychiatry, 11, 78. https://doi.org/10.3389/fpsyt.2020.00078

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(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Hogan, A., Catley, D., Goggin, K., & Evangeli, M. (2020). Mechanisms of Motivational Interviewing for Antiretroviral Medication Adherence in People with HIV. AIDS and behavior24(10), 2956–2965. https://doi.org/10.1007/s10461-020-02846-w(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Khadoura, K. J., Shakibazadeh, E., Mansournia, M. A., Aljeesh, Y., & Fotouhi, A. (2021). Effectiveness of motivational interviewing on medication adherence among Palestinian hypertensive patients: a clustered randomized controlled trial. European journal of cardiovascular nursing20(5), 411–420. https://doi.org/10.1093/eurjcn/zvaa015(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Mucci, A., Kawohl, W., Maria, C., & Wooller, A. (2020). Treating Schizophrenia: Open Conversations and Stronger Relationships Through Psychoeducation and Shared Decision-Making. Frontiers in psychiatry11, 761. https://doi.org/10.3389/fpsyt.2020.00761

National Institute of Mental health. (No date). Schizophrenia. Available at: https://www.nimh.nih.gov/health/statistics/schizophrenia (Accessed January 14, 2023)(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Palacio, A., Garay, D., Langer, B., Taylor, J., Wood, B. A., & Tamariz, L. (2019). Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis. Journal of general internal medicine31(8), 929–940. https://doi.org/10.1007/s11606-016-3685-3(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Papus, M., Dima, A. L., Viprey, M., Schott, A. M., Schneider, M. P., & Novais, T. (2022). Motivational interviewing to support medication adherence in adults with chronic conditions: systematic review of randomized controlled trials. Patient Education and Counseling.(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

Zomahoun, H. T. V., Guénette, L., Grégoire, J. P., Lauzier, S., Lawani, A. M., Ferdynus, C., Huiart, L., & Moisan, J. (2018). Effectiveness of motivational interviewing interventions on medication adherence in adults with chronic diseases: a systematic review and meta-analysis. International journal of epidemiology46(2), 589–602. https://doi.org/10.1093/ije/dyw273(Literature Synthesis and Evidence-Based Intervention Essay for Nursing Students)

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