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Evidence-Based Practice Project Assignment Research Paper

Evidence-Based Practice Project Assignment Research Paper

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Opioid use among pregnant women is a significant public health problem in the United States and globally. The Centers for Disease Control and Prevention (CDC) reported that opioid use diagnoses among pregnant women during delivery increased by 131% between 2010 and 2017.  CDC also highlighted the results of a 2019 self-reported survey that showed 7% of women used prescription pain relievers during pregnancy. 1 in 5 of these women misused opioids by obtaining them from sources other than their physicians and using them for other reasons (CDC, 2022). Opioid use disorder (OUD) is associated with increased morbidity and mortality (Goodman et al., 2020). It causes preterm births, poor fetal development, stillbirth, maternal mortality, and neonatal abstinence syndrome (NAS). Comprehensive care that addresses substance abuse, pregnancy, and delivery is required for pregnant women with OUD (CDC, 2022)Evidence-Based Practice Project Assignment Research Paper.  This paper presents a proposal for the implementation of an intervention for reducing maternal mortality in pregnant women with OUD in a small community hospital. The rest of the report contains sections on the problem statement, organizational culture and readiness, literature review, change model, and implementation and evaluation plans.

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Problem Statement

Opioid use disorder is a national and global epidemic. The Center for Drug Evaluation and Research observed OUD had risen to epidemic levels in the United States and worldwide (Center for Drug Evaluation and Research, 2019). Studies have indicated increased maternal deaths among opioid-addicted pregnant women compared with mothers without OUD. One such study is by Bruzelius and Martins (2022), which found an 81% mortality increase in women abusing opioids compared to 38% in non-drug dependent mothers. Pregnant women with OUD are also likely to have poor health outcomes. Also, their dependency on drugs could affect their children’s health. Lack of access to comprehensive care accelerates death rates in this patient population (Rizk et al., 2019).  Besides not having support from the family and the healthcare team heightens the death risk (Petersen et al., 2019).  Providing substance use treatment and maternity care can reduce addiction and improve maternal and child health (Rizk et al., 2019)Evidence-Based Practice Project Assignment Research Paper.

The current evidence-based practice project aims to examine if the comprehensive care package leads to decreased maternal mortality in women with opioid addiction. The following PICOT question will guide the project:

“In pregnant women who are opioid addicted (P), does providing a comprehensive set of services delivered in a coordinated and integrated approach(I) compared to opioid-addicted pregnant women receiving standard care (C) lead to a decrease in maternal deaths in ante/intrapartum/and postpartum patients (O) from day 43-365 days (T)?”

Organizational Culture and Readiness

Successful implementation of the proposed intervention depends on the hospital’s culture and readiness.  An analysis of the organizational culture, change readiness, stakeholders, project teams, and technology to facilitate the process is presented in this section of the report.

Organizational Culture

The organization where the EBP project will be implemented is a small community hospital.  Its mission is to create a healthcare environment where the community it serves can access quality and affordable services to achieve health restoration and general well-being. The community we serve is marked as underserved. The hospital aims to ensure holistic health. The organization also acknowledges the healthcare disparities affecting the community and hopes to make its services accessible. It also prioritizes prevention and treatment. The hospital upholds a few core values, including accountability, acceptance, diversity and inclusion, respect, teamwork, and collaboration, to achieve these overarching goals. The hospital is also committed to adopting practice changes that promote health.  It has also encouraged prevention and health promotion for vulnerable groups, including pregnant women.  The hospital would support a project that seeks to reduce deaths in opioid-addicted pregnant women. Evidence-Based Practice Project Assignment Research Paper

Organizational Readiness

Determining organizational readiness is another crucial step before implementation.  There are various tools for assessing readiness for change. One of the instruments is Organizational Readiness for Change Assessment (ORCA).  ORCA is an appropriate tool to assess the community hospital’s readiness to implement the comprehensive care package for decreasing maternal mortality.  ORCA has 74 items to evaluate an organization’s individual and system-based abilities to implement the proposal (Crittendon et al., 2020). The ORCA indicated the community hospital is ready for the EBP project. However, the hospital needs to enhance some individual and organizational capabilities. The survey showed the staff and the management acknowledge that maternal deaths in pregnant women with OUD are a problem in the hospital and community. The hospital demonstrates a commitment to decreasing maternal mortality. There is structure to support the process, such as the enabling organizational culture and supportive leadership. However, the staff would need training. Likewise, the staff would require resources to implement and sustain the proposed intervention.

Improving Change Readiness

A few strategies would boost organizational readiness for change. Before, implementing these interventions, it is essential to determine the stage of readiness. The trans-theoretical model can assess organizational change readiness. The model posits that in the event of change people or organizations can either be in the pre-contemplation, contemplation, or preparation phase (Vax et al., 2021)Evidence-Based Practice Project Assignment Research Paper. The assessment revealed that the community hospital is in contemplation. The staff and the hospital management are aware of the increased maternal deaths among opioid-addicted mothers.  Nonetheless, the staff requires training, while the management needs to understand the feasibility of the EBP project. The project leader should plan staff training and feasibility studies to enhance readiness. These strategies will prepare the organization for the implementation and improve the project outcomes.

Organizational Culture Role in Supporting and Sustaining the Practice Change

The hospital culture will support the implementation and sustain the EBP change. The organization’s collaborative culture will facilitate the provision of a comprehensive care package, which requires a multidisciplinary team.  Its commitment to prevention and treatment will also enhance implementation and sustain the project. Staff training and engagement of the management will improve the outcomes. The implementation and project sustainability will depend on the optimization of the organizational strengths and addressing the barriers.

Healthcare Process and Systems for Improving Care Safety, Quality, and Cost-effectiveness

               The community hospital needs a holistic perspective to care for pregnant women in antepartum, intrapartum, and postpartum.  The proposal is to provide comprehensive care to mothers with opioid addiction, encompassing risk assessment, brief intervention, and referral for advanced psychotherapy. These process-based measures will ensure timely care to improve maternal health and reduce opioid-use-related deaths. The hospital also needs to implement structural measures, such as a procedural policy that requires all pregnant attending antenatal at the facility to be assessed for OUD (Hoyland et al., 2022)Evidence-Based Practice Project Assignment Research Paper. These strategies will enhance healthcare quality, patient safety, and cost-effectiveness for opioid-addicted women.

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Stakeholders and Project Team

The proposed EBP project will involve various stakeholders. The stakeholders include physicians, nurses, psychotherapists, social workers, opioid-addicted mothers, and hospital management. Implementing the proposed intervention would mean changes in clinical workflows, affecting nurses’ and physicians’ work.  It would also require including psychotherapists, rehabilitation specialists, counselors, and social workers. Furthermore, the exercise will require restructuring the strategic direction of the hospital. The patients would also receive additional interventions. Stakeholder engagement will be crucial to addressing concerns and clarifying the project’s purpose.

The project team will be drawn from the identified stakeholders. They will include nurse leaders, nurse representatives, physician representatives, chief of operations, and quality assurance teams. This group will steer the project implementation. The nurse leader will lead the project. They will manage the project team and coordinate activities from planning to evaluation. The physicians will inform the project team about clinical recommendations for addiction. The quality assurance group and chief of operations will ensure the smooth implementation of the intervention by reviewing its effect on clinical workflows and care quality.

Information and Communication Technologies for the Implementation

The EBP project will require some technologies to enhance efficacy and cost-effectiveness. Telehealth, especially mHealth is an appropriate information and communication technology for the project. Mobile health solutions manage access barriers by allowing remote care and monitoring. Healthcare providers can send reminders, follow up, and educate opioid-addicted mothers undergoing comprehensive care through mobile platforms (Raynor et al., 2023). The community hospital can include the mHealth solution in the electronic healthcare records (EHR). The technology will improve acceptability and treatment adherence.

Literature Review

               A review of evidence related to the PICOT question was conducted. It involves 6 articles selected from online databases, CINAHL, PubMed, and Psych INFO.  The articles were obtained after passing the inclusion and exclusion criteria. The articles included in the literature review were about interventions for treating opioid use disorder or substance use in pregnant women. They were also published within a five-year range (from 2019 to 2023). Data extraction and analysis using a literature evaluation table were completed. In the following paragraphs, a synthesis of the six articles is presented.

Comprehensive Care Programs for OUD

Evidence supports the implementation of comprehensive care programs for pregnant women with OUD. Goodman et al. (2022) conducted a qualitative descriptive study to explore factors that enhance recovery and resilience in postpartum women with opioid addiction.  The researchers applied a focus group design to interview ten women on their experiences. The participants included women who had OUD and were undergoing substance use treatment. The findings indicated that the majority of the participants benefited from the program. The women stated that they could not access care before pregnancy because they lacked insurance and finances for cash payments. They also mentioned having to brave long waiting queues. However, the program enabled them to obtain and maintain care. The women reported they were more motivated. The support from the healthcare providers and their families has also been impactful. Based on these findings, access to care and provider and social support improves treatment compliance and health outcomes of opioid-addicted mothers. Evidence-Based Practice Project Assignment Research Paper

Awareness and Availability of Comprehensive Care Programs

There is widespread awareness and implementation of comprehensive care services for pregnant women in the U.S. Meinhofer et al. (2020) determined the prevalence and availability of substance use disorder (SUD) care services for pregnant and postpartum women (PPW). The researchers investigated the trends over time (from 2007 to 2018). They focused on the number of healthcare facilities that provided treatment services for women with SUD during this period. The team also studied the geographical distribution across the U.S. to check for availability and identify disparities. Besides, they evaluated the services provided in the facilities, including screening, treatment, supportive services, mode of delivery, and payer acceptance. The results showed a rise in outpatient facilities providing SUD care services to PPW from 2013 to 2018. However, the distribution was lower in some districts than in others. Pharmacotherapy was also the most provided SUD treatment service, with few facilities offering ancillary services, such as social assistance. Amid the demand for comprehensive care, as evidenced by Goodman et al. (2020)Evidence-Based Practice Project Assignment Research Paper, Meinhofer et al. (2020) highlighted disparities in substance use disorder treatment for pregnant women. An expansion of maternity care to incorporate SUD interventions is crucial.

Comprehensive Care Package Services

Based on the evidence reviewed, a comprehensive care package should include different services to meet the complex care needs of women with OUD.  Rizk et al. (2019) identified three aspects of care for opioid-addicted women in antepartum, intrapartum, and postpartum by analyzing a clinical case study. The researchers found that specialized care packages included screening for substance abuse, intervention, referral for advanced treatment, pregnancy, child delivery, and postpartum care. The findings also showed the significance of multidisciplinary practice in delivering the interventions (Rizk et al., 2019). These services ensure healthcare providers meet the needs of the mothers. Mazel et al. (2023) also outlined specific treatment strategies for SUD after performing a scoping review. The authors found that pharmacotherapy was one of the most popular services provided to women with OUD. Healthcare providers used buprenorphine and other drugs to control addiction. The patients also received psychotherapy and other ancillary services through collaborative and integrated care.  However, there was minimal application of harm reduction principles to prevent overdose deaths. Another study by Parlier-Ahmad et al. (2023) added patient education using the motivational interviewing method as a constituent of the bundled intervention for opioid-addicted mothers. The review supports including screening, treatment (pharmacological and non-pharmacological), harm reduction, and social assistance in the care bundle for pregnant women with opioid addiction.

Effectiveness of Comprehensive Care for Women with OUD

Studies that have investigated the effectiveness of comprehensive care for women with OUD found improved outcomes. Goodman et al. (2020) noted a reduction in addiction, improvement in the health of mother and child, and care for children with NAS among women who received comprehensive care. Similar observations were made by Singleton et al. (2022)Evidence-Based Practice Project Assignment Research Paper, who investigated outcomes in women who took medication for OUD. The researchers noted the women had controlled addiction, better maternal and child care, and improved efficacy in caring for children with NAS. The identified interventions can be effective in addressing addiction and associated complications.

Summary

Comprehensive care programs for opioid-addicted mothers ensure healthcare providers meet all patient needs, increase access, and enhance client recovery and resilience (Goodman et al., 2020; Meinhofer et al., 2020). The package should include screening, intervention (pharmacotherapy and psychotherapy), referral for advanced care, multidisciplinary care, harm reduction, and patient education (Mazel et al., 2023; Parlier-Ahmad et al., 2023; Rizk et al., 2019). The interventions reduce addiction, improve maternal and child health, and ensure care for NAS (Goodman et al., 2022; Singleton et al., 2022).

Change Model or Framework

Change models facilitate the implementation of evidence-based interventions. Several change models or frameworks exist. Selecting an appropriate model is significant. The current project will apply the social-ecological model of health.  The model adopts a holistic perspective on health. It underpins the World Health Organization (WHO) constitution (1947) that urges healthcare providers to adopt a broad perspective approach to patient care. The change model views health as an outcome of interactions between people, communities, and physical, social, and political contexts. It has been applied to implement different healthcare interventions (Agency for Toxic Substances and Disease Registry, 2023). In this section, the author describes the social-ecological model and how it applies to the identified problem and proposed practice changes.

Social Ecological Model Overview

               The social-ecological model has four domains represented in four concentric circles that outline multilevel factors affecting an individual’s health. The CDC recognizes four components of the model: individual, relationship, community, and societal (Refer to Appendix A). The individual level includes a person’s bio-physical attributes and other demographics, including age, health history, education, and income, which affect their health and general well-being. The relationship encompasses an individual social relation, such as family, friends, and partners, which influence behavior and experiences. The community level involves the environments in which people develop relationships, including schools, workplaces, and neighborhoods that affect health.  The societal band of the model includes broad factors that enhance or derail health. Educational, health, and economic policies, and social-cultural norms are examples of societal influences (Agency for Toxic Substances and Disease Registry, 2023).

Applying the Social Ecological Model to the Problem and Proposed Intervention

OUD in pregnant women is a significant health issue in the U.S. The problem results from various factors and needs a holistic approach (Jalali et al., 2020).  Opioid addiction in pregnant mothers is associated with individual, relationship, community, and societal-based influences. The biological and personal makeup of a person could increase the risk of opioid abuse. Also, relationships with family, friends, and partners can influence some individuals to misuse opioids.  Also, the neighborhood or the community in a person’s life could predispose them to opioid abuse. OUD is also prevalent in communities facing structural inequalities and healthcare disparities (Rizk et al., 2019). The multifaceted nature of opioid addiction supports the use of the social-ecological model to implement the recommended intervention.

               The change framework targets interventions to the four levels of influence. At the individual level interventions include addiction control, and maternal and child care. The package includes strategies for women in the antepartum, intrapartum, and postpartum phases. The opioid-addicted mothers will receive pharmacotherapy involving drugs, such as buprenorphine, naloxone, and methadone. The participants will also get behavioral therapy as part of routine prenatal, intrapartum, and postpartum care. Screening is also included at the individual level, targeting all pregnant women attending antenatal clinics. The risk assessment will also include newborns of opioid-addicted mothers to rule out NAS. Identified cases will be referred to an advanced treatment center (Hoyland et al., 2022). These strategies will ensure recovery and prevent complications, including maternal deaths.

The relationship level includes interventions that influence the social environment of pregnant women with OUD. Family and partner engagement in care is one strategy applied at this level. The family and loved ones of persons with OUD influence an individual’s recovery because they form the support network. Healthcare providers should educate the relatives on their role in OUD management, including support for medication adherence and caregiving for newborns (Rizk et al., 2019)Evidence-Based Practice Project Assignment Research Paper. The care team will collaborate with the family to improve treatment adherence and health outcomes.

The interventions at the community and societal levels focus on health promotion and ensuring access to care. Creating public awareness about opioid misuse risks among pregnant women in the community is an impactful intervention. Another community-level strategy would be collaborating with community health clinics around the hospital to improve screening for OUD and addiction control. At the societal level, the proposal is using a community-based approach, including mobile clinics, to allow marginalized communities to access substance-abuse care services (Rizk et al., 2019).  The interventions address community and broader societal risk factors for opioid addiction.

The described social ecological model will guide the implementation of comprehensive care for pregnant women with opioid addiction. The framework defines interventions and targeted stakeholders at each level.

Implementation Plan

                EBP project’s primary goal is to decrease maternal mortality among pregnant women with opioid addiction in antepartum, intrapartum, and postpartum by implementing a comprehensive bundle of services delivered in a coordinated and integrated approach. This section of the project proposal report outlines the implementation plan. It has various sections, including setting, timeline, budget/resource list, research methodology, evaluation, implementation, stakeholders, barriers and solutions, and feasibility.

Setting

                The EBP project is set to be implemented in a small community hospital. The hospital serves a community with persons with opioid use disorder (OUD). A recent hospital survey has indicated an increase in maternal mortality among opioid-addicted mothers. The facility records rising maternal deaths amid routine care. The standard care at the hospital for pregnant women involves antenatal, child delivery, and postnatal care for the mothers and their newborns. Based on the previous survey findings, maternal mortality is a problem the hospital needs to address. Opioid-addicted mothers are a special population that needs appropriate care to ensure sound health at antepartum, intrapartum, and postpartum (Jalali et al., 2020; Rizk et al., 2019). The community hospital should include substance abuse treatment and management in the routine care for pregnant women. The current project’s goal is to implement comprehensive care for pregnant individuals with OUD to enhance maternal and child health and decrease mortality rates. The project will examine pregnant women attending the facility for antenatal care. The project leader will seek permission from the hospital management before executing the intervention. They will send an authorization letter to the hospital leadership for approval (Refer to Appendix B for the sample letter). The participants will also sign a consent form (See Appendix C). The implementation of the project at the site will happen after the approval.

 

Timeline

The study is expected to take 365 days. The intervention will cover the participants from pregnancy to postpartum. During the prenatal period (before childbirth) the project team will identify addicted pregnant women, refer the patient to the addiction treatment center, initiate medication protocol with suboxone or methadone, and antenatal care at the community hospital. It will also determine the appropriate care team for various patients based on their needs. The next phase will be during labor and delivery (intrapartum). The participants will receive delivery and pediatric care. The postpartum phase will start when a participant is discharged until the 365th day. The collaboration of the obstetricians, support, and pediatric care teams will ensure long-term care for opioid-addicted mothers and children with NAS. Long-term care will involve weekly appointments with the rehab therapist, counselor, and social worker. The participants will also attend support groups every week. The project team will monitor maternal mortality every 90 days (quarterly) and after 365 days after childbirth (Refer to Appendix D for the detailed timeline)Evidence-Based Practice Project Assignment Research Paper.

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Budget/Resource List

The evidence-based practice project will require human capital and financial resources for the implementation of the proposed comprehensive care package. Staff training to prepare the nurses, obstetricians, and other care team members will be needed. The resources to execute the staff education include fees for an external trainer, training materials, and equipment. The trainer should be an individual who has knowledge and experience in comprehensive care for opioid-addicted mothers. The estimated cost of hiring the trainer is $5500 while the resources, including pamphlets, brochures, equipment, and facilitation expenses sum up to $6400.  The project team will utilize the hospital’s conference room, printing equipment, and projecting devices for the training exercise. Other costs the project will incur are monitoring and evaluation. Throughout the study period, the team will use $10000 in surveys, analysis, and results dissemination. The delivery of the bundled interventions is assumed to amount to $125000. The figure was obtained on the assumption that 50 participants will complete the study for $2500 (Refer to Appendix E for the budget and resource list). There are also unquantified costs, such as staff time because the project timeline is prolonged. Overall, the availability and proper management of the resources will ensure project implementation and sustainability.

Intervention Delivery

The project team will roll out the intervention in three phases: antepartum, intrapartum, and postpartum. In each of the phases, the participants will receive appropriate care. In the antepartum care phase, pregnant women who visit the community hospital for antenatal clinics will be screened for opioid addiction. Participants identified with OUD will be referred to the treatment hospital set within the facility for medication therapy and behavioral counseling. The patients will receive suboxone or methadone to manage addiction. They will also be placed under relevant care teams. During intrapartum (child labor, delivery, and a few days after birth), the care team will offer maternity care and support services, including pediatric care. In the postpartum (from discharge to the 365th day)Evidence-Based Practice Project Assignment Research Paper, the participants will receive long-term care. It will include weekly appointments with their teams, consisting of a rehab therapist, counselor, and social worker, and attendance at peer support groups. These interventions are expected to achieve holistic well-being for opioid-addicted mothers (Jalali et al., 2020). The staff will be trained on the intervention to enhance project outcomes. The comprehensive is expected to manage opioid addiction, improve mother and child health, and reduce maternal mortality.

 

Stakeholders

               The successful implementation of the project is pegged on the collaboration of several stakeholders.  Key stakeholders include pregnant women with OUD, healthcare providers, mental health therapists, social workers, and legal/law enforcement. Pregnant women with opioid addiction are at high risk of death by using opioids during pregnancy. The intervention targets this group to improve outcomes. Healthcare professionals are involved because of their obligation to provide quality and safe care. Opioid addiction negatively affects mother’s and child health. Mental health counselors and social workers also play a vital role in the recovery of opioid-addicted individuals.  They address the mental health and socioeconomic aspects of people with addiction. The legal/law enforcement agencies are concerned about the control of illegal drug use. From these stakeholder groups, a project team comprising obstetricians, physicians, nurses, mental health counselors, rehab therapists, and social workers, will be established. The team will have implemented the intervention in three project phases. The rehab therapists, behavioral counselors, and social workers will conduct long-term care and maintenance. Adequate stakeholder engagement and collaboration will ensure the project’s success.

Anticipated Barriers and Solutions

The implementation of comprehensive care to decrease mortality in opioid-addicted mothers could face a few barriers. Participants may decline enrolling in the program fearing apprehension by the law enforcement agencies. Normally, individuals with SUD fear seeking care to avoid arrests. The researcher will ensure anonymity to patients and only use the information for the research and individual health promotion. The assurance will increase the participation rate. The other challenge is finances due to the lengthy project timeline (Choi et al., 2023). The resources available to cover the intervention throughout the study period (365 days) could be limited. The project leader will help the hospital management apply for state funds for opioid control initiatives. Also, the dropout rate could be high due to the prolonged period. The team will follow up on the participants to enhance adherence and completion rate (Substance Abuse and Mental Health Services Administration, 2023).  The project team will apply the solutions outlined to address the barriers.

Implementation Plan Feasibility

               The implementation plan of the intervention to reduce maternal deaths among opioid-addicted mothers is feasible. The project will be executed at the cost of $146900 as per the budget prepared. The budget covers staff training, intervention delivery, and monitoring and evaluation. By implementing the plan, the community hospital will decrease maternal mortality. The organization will minimize reimbursement losses associated with such sentinel events under Medicare and Medicaid plans (Rizk et al., 2019). Implementing the plan will improve care for pregnant women with OUD and enhance the hospital’s financial performance.

Evaluation

               The project evaluation will involve assessing the expected outcomes. The primary outcome of the proposed EBP project is a decrease in maternal mortality in pregnant women with opioid addiction. The project team will also track secondary outcomes, such as study participation and completion rates, satisfaction/engagement, and cases of neonatal abstinence syndrome. The outcomes will be measured quarterly (90 days) and after the study (365th day). Examining these outcomes will provide the researcher with a broad perspective on intervention effectiveness (Elwy et al., 2020).

The evaluation will adopt a qualitative methodology to establish the impact of comprehensive care for pregnant women with OUD. The qualitative approach will enable the project team to obtain the participants’ experiences. A semi-structured questionnaire will collect data. Questionnaires are appropriate data collection tools because of their ability to investigate large samples (Taherdoost, 2021). The researcher will perform nonparametric tests, including the chi-square and linear regression analysis. The two tests are appropriate for qualitative data (Shreffler & Huecker, 2021).

               The questionnaire will collect data from the participants and the care teams on the selected primary and secondary outcomes. It will contain sections and questions for the patients and the healthcare providers (Refer to Appendix F for the questionnaire). The data analysis will be completed using the non-parametric tests and inferences made.

Based on the evaluation results, the project leader and team could take various actions. For instance, if the intervention does not decrease maternal mortality, the project leader will launch an investigation to determine the cause. An evident drop in maternal deaths, participation and completion rates, satisfaction, and engagement will indicate effectiveness. After the implementation, the project team could discontinue, revise, maintain the program, or extend the timeline depending on the evaluation results and the hospital’s capability.

Conclusion

               Pregnant women with opioid addiction are at high risk of maternal deaths and poor child outcomes. Comprehensive care delivered in a coordinated and integrated in antepartum, intrapartum, and postpartum phases can enhance mother and child health, and decrease mortality. The current project will implement a comprehensive package that includes screening, intervention, referral, and long-term care and maintenance.  The implementation period is 365 days. The evaluation of the primary and secondary outcomes will be conducted quarterly and after the study period. The evaluation results will help determine if to maintain, revise, extend, or discontinue the program.

References

Agency for Toxic Substances and Disease Registry (2023).  Models and frameworks for the practice of community engagement. In Principles of Community Engagement.  Agency for Toxic Substances and Disease Registry Centers for Disease Control and Prevention. https://www.atsdr.cdc.gov/communityengagement/pce_models.html.

Bruzelius, E., & Martins, S. S. (2022). US trends in drug overdose mortality among pregnant and postpartum persons, 2017-2020.  JAMA Network, 328(21), 2159-2161. https://doi.org/10.1001/jama.2022.17045.

CDC (2022). About opioid use during pregnancy. Centers for Disease Control and Prevention. https://www.cdc.gov/pregnancy/opioids/basics.html.

Center for Drug Evaluation and Research. (2019). Institutional review boards (IRBS) and protection of human subjects in clinical trials. U.S. Food and Drug Administration. https://www.fda.gov/about-fda/center-drug-evaluation-and-researchcder/institutional-review-boards-irbs-and-protection-human-subjects-clinical-trials.

Choi, S., Rosenbloom, D., Stein, M., Raifman, J., & Clark, J. (2023). Differential gateways, facilitators, and barriers to substance use disorder treatment for pregnant women and mothers: A scoping systematic review. Journal of Addiction Medicine, 16(3), 185-196. https://doi.org/10.1097/ADM.0000000000000909.

Crittendon, D. R., Cunningham, A., Payton, C., Mills, G., Kelly, S., LaNoue, M., & Arenson, C. (2020). Organizational readiness to change: Quality improvement in family medicine residency. PRiMER, 4(14), 1-6. https://doi.org/10.22454/primer.2020.441200. Evidence-Based Practice Project Assignment Research Paper

Elwy, A. R., Wasan, A. D., Gillman, A. G., Johnston, K. L., Dodds, N., McFarland, C., & Greco, C. M. (2020). Using formative evaluation methods to improve clinical implementation efforts: Description and an example. Psychiatry Research, 283 (112532), 1-6. https://doi.org/10.1016/j.psychres.2019.112532.

Goodman, D. J.,   Saunders, E. C., & Wolff, K. B. (2020). In their own words: A qualitative study of factors promoting resilience and recovery among postpartum women with opioid use disorders. BMC Pregnancy and Childbirth, 20(178), 1-10. https://doi.org/10.1186/s12884-020-02872-5.

Hoyland, S. A., Schuchert, A., & Mamen, A. (2022). A holistic perspective on continuing care for substance use and dependence: Results and implications from an in-depth study of a Norwegian continuing care establishment. Nordic Studies on Alcohol and Drugs, 39(5),469-584. https://doi.org/10.1177/14550725221099702.

Jalali, M. S., Botticelli, M., Hwang, R. C., Koh, H. K., & McHugh, R. K. (2020). The opioid crisis: A contextual, social-ecological framework. Health Research Policy and Systems, 18(87), 1-9.https://doi.org/10.1186/s12961-020-00596-8.

Mazel, S., Alexander, K., Cioffi, C., & Terplan, M. (2023). Interventions to support engagement in addiction care postpartum: Principles and pitfalls. Substance Abuse and Rehabilitation, 14, 49-59. https://doi.org/10.2147/SAR.S375652.

Meinhofer, A., Hinde, J. M., & Ali, M. M. (2020). Substance use disorder treatment services for pregnant and postpartum women in residential and outpatient settings. Journal of Substance Abuse and Treatment, 110, 9-17. https://doi.org/10.1016/j.jsat.2019.12.005.

Parlier-Ahmad, A. B., Eglovitch, M., Martin, S., Svikis, D.S., & Martin, C. E. (2023). Project BETTER: A family-centered, technology-delivered intervention for pregnant people with opioid use disorder. Children, 10(359), 1-8.https://doi.org/10.3390/children10020359. Evidence-Based Practice Project Assignment Research Paper

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Raynor, P., Corbett, C., West, D., Johnston, D., Eichelberger, K., Litwin, A., Guille, C., & Prinz, R. (2023). Leveraging digital technology to support pregnant and early parenting women in recovery from addictive substances: A scoping review.  International Journal of Environmental Research and Public Health, 20(4457), 1-14. https://doi.org/10.3390/ijerph20054457.

Rizk, A. H., Simonsen, S. E., Roberts, L., Taylor-Swanson, L., Lemoine, J. B., & Smid, M. (2019). Maternity care for pregnant women with opioid use disorder: A review. Journal of Midwifery and Women’s Health, 64(5), 532-544. https://doi.org/10.1111/jmwh.13019.

Shreffler, J., & Huecker, M. R. (2023). Types of variables and commonly used statistical designs. Treasure Island, FL: Stat Pearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557882/.

Singleton, R., Rutz, S., Day, G., Hammes, M., Wilson, A. S., Herrick, M., Mazut, C., Brunner, L., Prince, J., Desnoyers, C., Shaw, J., Hirschfeld, M., Palis, H., & Slaunwhite, A. (2022). Assessing the impact of prenatal medication for opioid use disorder on discharge home with parents among infants with neonatal opioid withdrawal syndrome. Journal of Addiction Medicine, 16(6), 366-373. https://doi.org/10.1097/ADM.0000000000000987.

Substance Abuse and Mental Health Services Administration (2023). Evidence-based, whole-person care for pregnant people who have opioid use disorder. Substance Abuse and Mental Health Services Administration Advisory. https://store.samhsa.gov/sites/default/files/pep23-02-01-002.pdf.

Taherdoost, H. (2021). Data collection methods and tools for research; A step-by-step guide to choosing. Data collection technique for academic and business research projects. International Journal of Academic Research in Management (IJARM),10 (1),10-38. https://hal.science/hal-03741847/document.

Vax, S., Gidugu, V., Farkas, M., & Drainoni, M. L. (2021). Ready to roll: Strategies and actions to enhance organizational readiness for implementation in community mental health. Implementation Research and Practice, 2, 1-11.https://doi.org/10.1177/2633489520988254. Evidence-Based Practice Project Assignment Research Paper

Appendices

Appendix A: Change Model/Framework: Social Ecological Model

Appendix B: Site Authorization Letter

 

Organization Letterhead

Company Name

Address

Site Contact

Date

 

Office of Academic Research

Grand Canyon University

College of Doctoral Studies

3300 W. Camelback Road

Phoenix, AZ  85017

Phone:  602-639-7804

 

Dear IRB Members,

 

After reviewing the proposed project—————-presented by ———————-I have granted authorization for ——————————–to conduct research at our ———————————————————————————————

I understand the purpose of the project is to implement a comprehensive set of services, including assessment for opioid use disorder, brief intervention and referral, and postnatal addiction treatment for the mothers and neonates, to reduce maternal mortality in opioid-addicted pregnant mothers at the community hospital.

I have indicated to Researcher Name that ——————————————————-will allow the following research activities: data collection and document access. We will cooperate with the researcher in project implementation, monitoring, and evaluation.

The participants of the study should meet the following criteria:

  • Be a pregnant woman
  • Be currently seeking antenatal care at the facility

To ensure that the patients are protected, the Researcher has agreed to provide a copy of the informed consent form and recruitment methods before recruiting participants at the community hospital. I understand details that might identify the organization will not be published, and the researcher will take necessary measures to ensure data security. Researcher Name has agreed to provide a copy of the project outcomes to the hospital.

Sincerely,

Authorizing Site Official signature

Title

___________________________________________

Printed Name

___________________________________________

Signature Date

Appendix C: Informed Consent

Informed Consent

Title of Study

Determining the impact of comprehensive care on maternal mortality in opioid-addicted pregnant women in antepartum, intrapartum, and postpartum compared with standard care. Evidence-Based Practice Project Assignment Research Paper

Principal Investigator

[Name]

[Department]

[Address]

[Phone]

[Email]

Purpose of Study

You are requested to participate in this study. Before making a decision, read the following information and respond as appropriate. If there is anything you do not understand, kindly consult the researcher. The project aims to implement comprehensive services for opioid-addicted pregnant women to improve maternal and child outcomes and maternal mortality rates over 365 days.

Study Procedures

            The study will include patient assessment to identify opioid-addicted pregnant patients. This will be conducted on pregnant women presenting for antenatal care. Patients with OUD will be referred to the addiction treatment center to begin medication protocol with methadone/suboxone. A care team will also be established to handle the intrapartum (before and during childbirth). Support services will also be provided for the newborn. The postpartum period (hospital discharge day to day 365) will involve long-term and maintenance care.  The long-term care will include weekly appointments with the care team, including a rehab therapist, social worker, and counselor. The participants will also be encouraged to attend weekly support groups. The researcher will also monitor the participants for mortality and other outcomes.

Risks

            Personal information may leak during the study period. The researcher will take measures to secure data, such as using codes to conceal the participants’ identities. Participants will also be allowed to request deletion of their information if they drop out of the intervention.

Benefits

Participating in the study will help opioid-addicted pregnant women manage their addiction and maintain health at no cost. The community will use the results to support further implementation of comprehensive care.

Confidentiality

The researcher will ensure anonymity. They will not include any identification details. Codes will be assigned to the participant’s personal information. The researcher will also store the data in encrypted formats.

Contact Information

Kindly contact the researcher any time you feel concerned about any aspect of this research using the details provided on the first page of this informed consent form.

Voluntary Participation

Participating in this project is voluntary. If you decide to participate in the study, you will be required to sign the consent form. You can withdraw from the study at any period after signing the form.  Withdrawing from the project will not affect your relationship with the researcher or the community hospital.

Consent

I have read and understood the information herein, and I have made inquiries. I understand my participation is voluntary, and I can withdraw without explaining or incurring costs.  I voluntarily decided to participate in the study. Evidence-Based Practice Project Assignment Research Paper

 

Participant’s signature ______________________________ Date __________

 

Investigator’s signature _____________________________ Date __________

 

Appendix D:  Timeline

Project Activities Timeline (in days or weeks)
Staff Training on OUD patient care and NAS care 2 weeks before the project implementation
Prenatal Period: Opioid addiction assessment; care plan with relevant team based on patient needs and initiation of care for the identified addicted pregnant patients. From enrollment day to delivery day
Intrapartum Period:  (During labor, delivery, and a few days after delivery). From the labor onset to discharge the day after delivery
Postpartum Period: (Discharge day to the 365th day)

Care teams collaborate for long-term care and maintenance, including weekly appointments and attendance at peer support groups.

 

From discharge day to the 365th day
Evaluation, data analysis, and reporting Quarterly evaluation every 90 days from discharge day. Researchers evaluated the mortality rates among the addicted pregnant patients who participated in the study over 365 days.  Analyze and report data after every quarterly evaluation and at the end of the project.

 

Appendix E: Budget/ Resource List

Particulars/ Activities Cost in US $
External staff trainer $5500
Staff training materials and facilitation (printed brochures, pamphlets, presentations, rooms, and refreshments).

 

$6400
Interventions-Prenatal care, intrapartum, and postpartum care The estimated cost of treating one patient is $2500. If 50 patients participate in the study, the cost will be $125000
Monitoring and evaluation study- (data  collection,  analysis, report writing, and dissemination) $10000 (ongoing cost- evaluation to be done quarterly for continued quality improvement)
Personnel- obstetricians, nurses,  pediatricians, and ancillary staff-social workers/support No new staff needs to be hired.
Total Estimated Cost $146900

 

Appendix F: An Excerpt of the Study Questionnaire

The research questionnaire aims to determine the effectiveness of comprehensive care for opioid-addicted pregnant women to improve clinical outcomes and mortality rates in antepartum, intrapartum, and postpartum patients compared with standard care. The participants were to fill out the questionnaire as required. NB: Kindly do not include personal details other than the requested information.

Section A: Demographics

 

Responses
1.      Age

 

 

—– age in years

2.      Marital status Single☐

Married☐

Divorced☐

In a relationship/domestic partnership ☐

3.      Level of Education

 

Elementary☐

High School Diploma☐

Bachelor’s Degree and above☐

4.      Employment status Employed☐

Self-employed☐

Unemployed☐

5.      Gestation age at the time of enrollment

 

—- weeks
6.      Does a patient have an OUD? Confirm through screening Yes☐

No ☐

7.      Types of drugs abused Enter as appropriate
Section B: Patients Responses
1.      How has the intervention affected your opioid addiction? Enter your response here
2.      What services did you receive?
3.      Which services provided during prenatal care, labor, childbirth, and after delivery were most impactful and why?
4.      What factors encouraged you to participate in the project?
For Healthcare Providers
1.      How was your experience delivering the proposed intervention? Was it better than usual care? Yes

No(Mark as appropriate)

2.      Would you propose the continuation of the intervention after the study period? Give reasons.
3.      What improvements would you propose to refine the comprehensive care for opioid-addicted pregnant mothers?
4.      How were your clinical skills improved during this study? Explain

 

Appendix G: GCU’s APA Writing Checklist

Use this document as a checklist for each paper you will write throughout your GCU graduate program. Follow specific instructions indicated in the assignment and use this checklist to help ensure correct grammar and APA formatting. Refer to the APA resources available in the GCU Library and Student Success Center.

☒ APA paper template (located in the Student Success Center/Writing Center) is utilized for the correct format of the paper. APA style is applied, and the format is correct throughout.

☒  The title page is present. APA format is applied correctly. There are no errors.

☒ The introduction is present. APA format is applied correctly. There are no errors.

☒ Topic is well defined.

☒ A strong thesis statement is included in the introduction of the paper.

☒ The thesis statement is consistently threaded throughout the paper and included in the conclusion.

☒ Paragraph development: Each paragraph has an introductory statement, two or three sentences as the body of the paragraph, and a transition sentence to facilitate the flow of information. The sections of the main body are organized to reflect the main points of the author. APA format is applied correctly. There are no errors.

☒ All sources are cited. APA style and format are correctly applied and are free from error.

☒ Sources are completely and correctly documented on a References page, as appropriate to the assignment and APA style, and the format is free of error.

Scholarly Resources: Scholarly resources are written with a focus on a specific subject discipline and are usually written by an expert in the same subject field. Scholarly resources are written for an academic audience.

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Examples of Scholarly Resources include Academic journals, books written by experts in a field, and formally published encyclopedias and dictionaries.

Peer-Reviewed Journals: Peer-reviewed journals are evaluated before publication by experts in the journal’s subject discipline. This process ensures that the articles published within the journal are academically rigorous and meet the required expectations of an article in that subject discipline.

Empirical Journal Article: This type of scholarly resource is a subset of scholarly articles that report the original findings of an observational or experimental research study. Common aspects found within an empirical article include literature review, methodology, results, and discussion.

Adapted from “Evaluating Resources: Defining Scholarly Resources,” located in Research Guides in the GCU Library. Evidence-Based Practice Project Assignment Research Paper

For this assignment, you will synthesize the independent evidence-based practice project proposal assignments from NUR-550 and NUR-590 into a 4,500-5,000-word professional paper.

Final Paper

The final paper should:

Incorporate all necessary revisions and corrections suggested by your instructors.
Synthesize the different elements of the overall project into one paper. The synthesis should reflect the main concepts for each section, connect ideas or overreaching concepts, and be rewritten to include the critical aspects of the project (do not copy and paste the assignments).
Contain supporting research for the evidence-based practice project proposal.
Main Body of the Paper

The main body of your paper should include the following sections:

Problem Statement
Organizational Culture and Readiness
Literature Review
Change Model or Framework
Implementation Plan
Evaluation Plan
Appendices

The appendices at the end of your paper should include the following:

Complete the “APA Writing Checklist,” provided in Class Resources, to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as the final appendix at the end of your paper. In each preceding course, you have been directed to the Student Success Center for assistance with APA style and have submitted the “APA Writing Checklist” to help illustrate your adherence to APA style. This final paper should demonstrate a clear ability to communicate your project in a professional and accurately formatted paper using APA style.
General Requirements

You are required to cite 10-12 peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

MBA-MSN; MSN

1.1: Translate research and knowledge gained from practice, while adhering to ethical research standards, to improve patient outcomes and clinical practice.

5.1: Design ethically sound, evidence-based solutions to complex health care issues related to individuals, populations, and systems of care.

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