Clinical Issue Discussion Paper

Clinical Issue Discussion Paper

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Stigma is a subjective process that makes individuals develop negative feelings about themselves due to prevailing conditions. The issue of mental health and addiction is mainly subjected to stereotypes, with most of these patients failing to seek medical intervention, thus risking these patients’ well-being (Avery & Avery, 2019)Clinical Issue Discussion Paper. Such stigmatization also exists among healthcare providers, thus making them present bias when treating mental health and addiction patients. In that case, my PICO question is, “Do mental health and addiction patients’ stigma levels change after exposure to public stigma interventions compared to those with no such stigma interventions? From the question, the Population under study is the mental health and addiction patients; Intervention is public stigma interventions, Comparison being the absence of no stigma intervention, and the Outcome changing of stigma levels.

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When searching for the articles, the top search terms used were mental illness, addiction disorders, public stigma interventions, mental illness stigma, and addiction stigma. Regarding the database used, the research engaged PubMed Central, Web of Science, and Google Scholar. In that case, PubMed Central initially provided 19564 results, Web of Science, 16, 494 results, and Google Scholar 18, 065 results. However, after limiting the search parameter by searching for articles within the last five years, the results were 12,384 results, 13,123 results, and 14,503, respectively. Also, after engaging the Boolean parameters using mental health and addiction patients as a keyword, the results narrowed further to 8,732 results, 9,231 results, and 11, 896, respectively.

When addressing the rigor and effectiveness factors for my research, I have realized that I need to engage different strategies to ensure that I get the most compelling articles to answer my PICO question. These strategies will include enhancing the search limiters to help me identify the specific articles for the research, like combining search terms like mental illness and stigma levels (Dhollande et al., 2021). Also, the identified peer-reviewed articles reference lists will need to be screened to evaluate other relevant studies (Spurlock et al., 2019)Clinical Issue Discussion Paper.

References

Avery, J. D., & Avery, J. J. (Eds.). (2019). The stigma of addiction: An essential guide. Springer.

Dhollande, S., Taylor, A., Meyer, S., & Scott, M. (2021). Conducting integrative reviews: A guide for novice nursing researchers. Journal of Research in Nursing, 26(5), 427-438. https://doi.org/10.1177/1744987121997907

Spurlock Jr, D. (2019). Searching the literature in preparation for research: Strategies that matter. Journal of Nursing Education, 58(8), 441-443. https://doi.org/10.3928/01484834-20190719-0

Clinical Issue Description

• The clinical issue concerns how public stigma interventions influence mental health and addiction patients’ stigma levels.
• That is when it is compared with patients not exposed to such public stigma interventions.
• Patients with mental health and addiction issues fail to seek healthcare services because they fear that they might be judged wrongly by healthcare providers.
• The selected research articles evaluate the stigmatization imposed on these patient populations at different levels Clinical Issue Discussion Paper
• Four Databases for the Peer-Review Articles

• CINAHL and PubMed Central due to availability of full-text articles.
• PubMed database due to variety of articles related to my PICO question
• Google Scholar due to its provision of reliable scholarly articles.

Developing my PICO Question

• The main factors considered for the successful development of the PICO question include;
• The patient population includes mental health and addiction patients.
• Interventions involve exposure to public interventions.
• Comparison is on a patient population with no public interventions on stigma.
• The outcome is the reduction of stigmatization levels.
  

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APA Citations for the Four Selected Articles

Al Saif, F., Al Shakhoori, H., Nooh, S., & Jahrami, H. (2019). Association between attitudes of stigma toward mental illness and attitudes toward adoption of evidence-based practice within health care providers in Bahrain. PloS one, 14(12), e0225738. https://doi.org/10.1371/journal.pone.0225738

Mejia-Lancheros, C., Lachaud, J., O’Campo, P., Wiens, K., Nisenbaum, R., Wang, R., … & Stergiopoulos, V. (2020). Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness. PloS one, 15(2), e0229385. https://doi.org/10.1371/journal.pone.0229385 Clinical Issue Discussion Paper

Sherwood, D. A. (2019). Healthcare curriculum influences on stigma towards mental illness: Core psychiatry course impact on pharmacy, nursing and social work student attitudes. Currents in Pharmacy Teaching and Learning, 11(2), 198-203. https://doi.org/10.1016/j.cptl.2018.11.001

Werremeyer , A., Mosher, S., Eukel, H., Skoy, E., Steig, J., Frenzel, O., & Strand, M. A. (2021). Pharmacists’ stigma toward patients engaged in opioid misuse: When “social distance” does not mean disease prevention. Substance Abuse, 42(4), 919-926. https://doi.org/10.1080/08897077.2021.1900988

Level of Evidence of the Above Peer-Reviewed Articles

• The above peer-reviewed articles are qualitative and focus on a specific patient group.
• According to Melnyk & Fineout-Overholt’s (2018) level of evidence in nursing, the chosen articles fall under Level VI of evidence.
• Thus, in the long run, the researcher may not be able to generalize such results.
• Hence, to sustain the credibility and reliability of the selected, there was the need to engage other articles at quantitative level, which include;

Waqas, A., Malik, S., Fida, A., Abbas, N., Mian, N., Miryala, S., … & Naveed, S. (2020). Interventions to reduce stigma related to mental illnesses in educational institutes: a systematic review. Psychiatric Quarterly, 91(3), 887-903. https://doi.org/10.1007/s11126-020-09

Rao, D., Elshafei, A., Nguyen, M., Hatzenbuehler, M. L., Frey, S., & Go, V. F. (2019). A systematic review of multi-level stigma interventions: state of the science and future directions. BMC medicine, 17(1), 1-11. https://doi.org/10.1186/s12916-018-1244-y

• The above articles are quantitative articles that will enhance the initial articles’ research findings.
• They fall under Level I and Level II evidence consecutively.
• According to Stillwell et al. (2010), strong evidence quantitative research should engage in randomization to prevent instances of biases.
• For instance, Waqas et al. (2020) and Rao et al. (2019) use randomized samples, thus reducing biases.
• Also, such research articles enable research findings generalization Clinical Issue Discussion Paper.

References

Al Saif, F., Al Shakhoori, H., Nooh, S., & Jahrami, H. (2019). Association between attitudes of stigma toward mental illness and attitudes toward adoption of evidence-based practice within health care providers in Bahrain. PloS one, 14(12), e0225738. https://doi.org/10.1371/journal.pone.0225738

Mejia-Lancheros, C., Lachaud, J., O’Campo, P., Wiens, K., Nisenbaum, R., Wang, R., … & Stergiopoulos, V. (2020). Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness. PloS one, 15(2), e0229385. https://doi.org/10.1371/journal.pone.0229385

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Rao, D., Elshafei, A., Nguyen, M., Hatzenbuehler, M. L., Frey, S., & Go, V. F. (2019). A systematic review of multi-level stigma interventions: state of the science and future directions. BMC medicine, 17(1), 1-11. https://doi.org/10.1186/s12916-018-1244-y

Stillwell, S. B. , Fineout-Overholt, E. , Melnyk, B. M. & Williamson, K. M. (2010). Evidence-Based Practice, Step by Step: Asking the Clinical Question. AJN, American Journal of Nursing, 110 (3), 58-61. doi: 10.1097/01.NAJ.0000368959.11129.79.

Sherwood, D. A. (2019). Healthcare curriculum influences on stigma towards mental illness: Core psychiatry course impact on pharmacy, nursing and social work student attitudes. Currents in Pharmacy Teaching and Learning, 11(2), 198-203. https://doi.org/10.1016/j.cptl.2018.11.001

Werremeyer , A., Mosher, S., Eukel, H., Skoy, E., Steig, J., Frenzel, O., & Strand, M. A. (2021). Pharmacists’ stigma toward patients engaged in opioid misuse: When “social distance” does not mean disease prevention. Substance Abuse, 42(4), 919-926. https://doi.org/10.1080/08897077.2021.1900988

Waqas, A., Malik, S., Fida, A., Abbas, N., Mian, N., Miryala, S., … & Naveed, S. (2020). Interventions to reduce stigma related to mental illnesses in educational institutes: a systematic review. Psychiatric Quarterly, 91(3), 887-903. https://doi.org/10.1007/s11126-020-09 Clinical Issue Discussion Paper

• The clinical issue concerns how public stigma interventions influence mental health and addiction patients’ stigma levels.
• That is when it is compared with patients not exposed to such public stigma interventions.
• Patients with mental health and addiction issues fail to seek healthcare services because they fear that they might be judged wrongly by healthcare providers.
• The selected research articles evaluate the stigmatization imposed on these patient populations at different levels.

                                             Four Databases for the Peer-Review Articles

• CINAHL and PubMed Central due to availability of full-text articles.
• PubMed database due to variety of articles related to my PICO question
• Google Scholar due to its provision of reliable scholarly articles.

Developing my PICO Question

• The main factors considered for the successful development of the PICO question include;
• The patient population includes mental health and addiction patients.
• Interventions involve exposure to public interventions.
• Comparison is on a patient population with no public interventions on stigma.
• The outcome is the reduction of stigmatization levels.

APA Citations for the Four Selected Articles

Al Saif, F., Al Shakhoori, H., Nooh, S., & Jahrami, H. (2019). Association between attitudes of stigma toward mental illness and attitudes toward adoption of evidence-based practice within health care providers in Bahrain. PloS one, 14(12), e0225738. https://doi.org/10.1371/journal.pone.0225738

Mejia-Lancheros, C., Lachaud, J., O’Campo, P., Wiens, K., Nisenbaum, R., Wang, R., … & Stergiopoulos, V. (2020). Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness. PloS one, 15(2), e0229385. https://doi.org/10.1371/journal.pone.0229385

Sherwood, D. A. (2019). Healthcare curriculum influences on stigma towards mental illness: Core psychiatry course impact on pharmacy, nursing and social work student attitudes. Currents in Pharmacy Teaching and Learning, 11(2), 198-203. https://doi.org/10.1016/j.cptl.2018.11.001

Werremeyer , A., Mosher, S., Eukel, H., Skoy, E., Steig, J., Frenzel, O., & Strand, M. A. (2021). Pharmacists’ stigma toward patients engaged in opioid misuse: When “social distance” does not mean disease prevention. Substance Abuse, 42(4), 919-926. https://doi.org/10.1080/08897077.2021.1900988 Clinical Issue Discussion Paper

Level of Evidence of the Above Peer-Reviewed Articles

• The above peer-reviewed articles are qualitative and focus on a specific patient group.
• According to Melnyk & Fineout-Overholt’s (2018) level of evidence in nursing, the chosen articles fall under Level VI of evidence.
• Thus, in the long run, the researcher may not be able to generalize such results.
• Hence, to sustain the credibility and reliability of the selected, there was the need to engage other articles at quantitative level, which include;

Waqas, A., Malik, S., Fida, A., Abbas, N., Mian, N., Miryala, S., … & Naveed, S. (2020). Interventions to reduce stigma related to mental illnesses in educational institutes: a systematic review. Psychiatric Quarterly, 91(3), 887-903. https://doi.org/10.1007/s11126-020-09

Rao, D., Elshafei, A., Nguyen, M., Hatzenbuehler, M. L., Frey, S., & Go, V. F. (2019). A systematic review of multi-level stigma interventions: state of the science and future directions. BMC medicine, 17(1), 1-11. https://doi.org/10.1186/s12916-018-1244-y

• The above articles are quantitative articles that will enhance the initial articles’ research findings.
• They fall under Level I and Level II evidence consecutively.
• According to Stillwell et al. (2010), strong evidence quantitative research should engage in randomization to prevent instances of biases.
• For instance, Waqas et al. (2020) and Rao et al. (2019) use randomized samples, thus reducing biases.
• Also, such research articles enable research findings generalization Clinical Issue Discussion Paper.

 References

Al Saif, F., Al Shakhoori, H., Nooh, S., & Jahrami, H. (2019). Association between attitudes of stigma toward mental illness and attitudes toward adoption of evidence-based practice within health care providers in Bahrain. PloS one, 14(12), e0225738. https://doi.org/10.1371/journal.pone.0225738

Mejia-Lancheros, C., Lachaud, J., O’Campo, P., Wiens, K., Nisenbaum, R., Wang, R., … & Stergiopoulos, V. (2020). Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness. PloS one, 15(2), e0229385. https://doi.org/10.1371/journal.pone.0229385

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Rao, D., Elshafei, A., Nguyen, M., Hatzenbuehler, M. L., Frey, S., & Go, V. F. (2019). A systematic review of multi-level stigma interventions: state of the science and future directions. BMC medicine, 17(1), 1-11. https://doi.org/10.1186/s12916-018-1244-y

Stillwell, S. B. , Fineout-Overholt, E. , Melnyk, B. M. & Williamson, K. M. (2010). Evidence-Based Practice, Step by Step: Asking the Clinical Question. AJN, American Journal of Nursing, 110 (3), 58-61. doi: 10.1097/01.NAJ.0000368959.11129.79.

Sherwood, D. A. (2019). Healthcare curriculum influences on stigma towards mental illness: Core psychiatry course impact on pharmacy, nursing and social work student attitudes. Currents in Pharmacy Teaching and Learning, 11(2), 198-203. https://doi.org/10.1016/j.cptl.2018.11.001

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Werremeyer , A., Mosher, S., Eukel, H., Skoy, E., Steig, J., Frenzel, O., & Strand, M. A. (2021). Pharmacists’ stigma toward patients engaged in opioid misuse: When “social distance” does not mean disease prevention. Substance Abuse, 42(4), 919-926. https://doi.org/10.1080/08897077.2021.1900988

Waqas, A., Malik, S., Fida, A., Abbas, N., Mian, N., Miryala, S., … & Naveed, S. (2020). Interventions to reduce stigma related to mental illnesses in educational institutes: a systematic review. Psychiatric Quarterly, 91(3), 887-903. https://doi.org/10.1007/s11126-020-09  Clinical Issue Discussion Paper

• Identify and briefly describe your chosen clinical issue of interest.
• Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
• Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
• Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
• Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

SOURCES will be the four previously chosen articles which I will attach AND a complete, detailed, and accurate synthesis of TWO more outside resources related to the peer-reviewed articles selected, and TWO course-specific resources that fully support the presentation.

COURSE resources include :
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 2, “Asking Compelling Clinical Questions” (pp. 33–54)
Chapter 3, “Finding Relevant Evidence to Answer Clinical Questions” (pp. 55–92)

Stillwell, S. B. , Fineout-Overholt, E. , Melnyk, B. M. & Williamson, K. M. (2010). Evidence-Based Practice, Step by Step: Asking the Clinical Question. AJN, American Journal of Nursing, 110 (3), 58-61. doi: 10.1097/01.NAJ.0000368959.11129.79.

Stillwell, S. B. , Fineout-Overholt, E. , Melnyk, B. M. & Williamson, K. M. (2010). Evidence-Based Practice, Step by Step: Searching for the Evidence. AJN, American Journal of Nursing, 110 (5), 41-47. doi: 10.1097/01.NAJ.0000372071.24134.7e.

https://academicguides.waldenu.edu/library/healthevidence/types#s-lg-box-1520654

https://academicguides.waldenu.edu/library/keyword/intro