When considering a clinical question for nursing practice, it is important to be certain that the question is one that has an appropriate population, an appropriate intervention to be tried, a comparison made with current practice, and outcomes (measures of whether the intervention was significantly better than the interventions being used in current practice) stated so that everyone using the intervention is aware of the difference. The method for forming such a clinical question is appropriately named the PICO method, after the four stages involved in forming the question.
Before a question can be considered, however, one must find things to compare—how intervention A will result in the health change of Participant A. And in this case, some definitions are required so that a reasonable understanding can take place. Addiction is defined as “1) a strong and harmful need to regularly have something (such as a drug) or do something (such as gamble) or 2) an unusually great interest in something or a need to do or have something” (Merriam Webster, 2015). In general, it is the first entry that is under consideration, although the second one can also be a treatable addiction, such as stalking behavior. In terms of health promotion, it can be defined as a state or process that is “directed at increasing a client’s level of well being” (Current Nursing, 2012).
A clinical question appropriate for addiction and health promotion might be “Is the monitoring of addiction in substance abuse patients the same for all patients across the time in treatment, or is it selected based on factors related to culture or other health factors, such as concurrent diseases?” This question contains all the elements of PICO, and it goes directly to health promotion as defined above. Three research studies in particular drive this question: Rajaram and Bockrath (2014), Thibault, Brissette, and Jutras-Aswad (2015), and Casadio, Olivoni, Ferrari, Pintori, Speranza, Bosi, Belli, Baruzzi, Pantieri, Ragazzini, Rivola and Atti (2014). The authors, respectively, discussed cultural competence and health disparities, alcohol use and hepatitis C, and personality disorders and addiction.
The clinical question addresses substance abuse patients, who represent a significant population of those who are likely referred for treatment, since these individuals seldom self-refer. But addictions are a significant public health threat. Bruzy (n.d.) indicates that though America’s population in only 4% of the world’s population, an astonishing 9.5% of the world’s illegal drugs are consumed here. Drug and other substance abuse occurs across all racial and ethnic groups and subgroups, though specificall which substances are used by whom is subject to those constraints (National Institutes of Health, 1995). Drug abuse and addiction also varies across medical conditions (Dryden-Edwards, 2014). Since we in the health field see a great many of these people, it is important for us to continually improve treatments for addiction, and to be aware of and follow the latest information in the field.
Our clinical question infers that some type of intervention occur in the treatment of addiction in substance abuse patients. This is included based on the work of the authors mentioned above, namely Rajaram and Bockrath (2014), Thibault, Brissette, and Jutras-Aswad (2015), and Casadio, Olivoni, Ferrari, Pintori, Speranza, Bosi, Belli, Baruzzi, Pantieri, Ragazzini, Rivola and Atti (2014). The specific nursing intervention involves monitoring patients in treatment to determine the relative efficacy of treatment being offered, and whether making changes based on previously-diagnosed disease in some patients or whether there are cultural factors that affect treatment is a better approach to treatment than simply offering a treatment for substance abuse addiction that simply runs its course and is done. This is the approach most often used in the treatment of behavior problems. The implications for nursing practice are enormous. If different subjects respond to a better, more personal treatment option, then perhaps there will be lower rates of recidivism and a healthier population going forward than would otherwise be the case. If they don’t, based on the findings, then we will be more certain that current methodologies of treatment are most effective. In either case, we will have learned something valuable that we don’t know at the present time.
The comparative choice is clear. Our present method of dealing with addiction is to place patients in a program for addicts and then release them when they graduate. Of course it is a nationally well-known program, and has a track record of success. Information about the patient, including medical, family and cultural factors is taken at the beginning. Everything is present to make a comparison, and to engage in a program designed to get at the causes and supports of the addictions, but that information is not used to treat them, only to identify them. Casadio, Olivoni, Ferrari, Pintori, Speranza, Bosi, Belli, Baruzzi, Pantieri, Ragazzini, Rivola and Atti (2014) state their study concerns “the prevalence of personality disorders (PDs) in the outpatients attending an addiction service, with particular attention to the effects of PDs on social and occupational functioning and on the intensity of treatment required.” Thibault, Brissette, and Jutras-Aswad (2015) state that “Treating alcohol use disorders (AUD) is critical in individuals suffering from hepatitis C infection (HCV). Aside from psychosocial interventions, pharmacological treatment is effective for decreasing alcohol consumption and promoting abstinence. However, unique factors belonging to HCV-infected individuals, such as baseline hepatic vulnerability and possible ongoing hepatitis C treatment, complicate AUD drug therapy.” Rajaram and Bockrath (2014) believe that “[t]he increasing interest in the role of racism and racialization in health disparities, calls for exploring new paradigms in addressing and eliminating health disparities related to race/ethnicity.” In doing all these things, and in utilizing all the information we have, is the best way to proceed. In this way, treatment is truly evidence-based.
The outcome depends to a large extent on how well we use the information we have about each patient. The expected impact of the treatment is that there will be a decreased rate of recidivism in this type of program. It may, of course, take smaller groups and more therapists to succeed, as wel an increased emphasis on the intake proceedings. Additional research may focus on the various aspects of therapy, rather than this kind of therapy on the whole. The outcome also depends on how well the therapy program is monitored, paying especial attention to areas that present a hindrance to treatment. The whole effort ought to be comprehensive in nature, with very careful records kept.