NURS FPX 9902 Assessment 3

NURS FPX 9902 Assessment 3 Literature Synthesis

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A literature synthesis is a comprehensive examination of and the integration of all the research that has been carried out on a certain topic in order to identify the key themes, results and areas of what is unknown. The purpose of a survey is not just a summary of studies; it focuses on the relationships and patterns in various sources with great finesse and presents a whole and useful picture of what has been done in a certain field of research. In order to reduce the recurrence rate of hospital readmissions of opioid-addicted patients, individualized Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI) should be employed. To achieve this, literature synthesis would entail a thorough review and compilation of findings of studies that have explored the effectiveness of these interventions, how to implement them, and at what cost (Zhu et al., 2023). Finally, this may result in the development of evidence-based practices that reduce the number of individuals who recidivate after recovering from opioid addiction disorder.

Literature Search Strategy

While the original search, the several significant changes were made to make a book search even better. The new search covered many crucial sources including CINAHL, PubMed, and the Cochrane Library. We also applied broader spectrum of keywords and Medical Subject Headings (MeSH) terms in search strategies. By using logical operators (AND, OR) and database-specific categories (release date, peer-reviewed, and adult population) better search results were achieved. Apart from that, catalogs of pertinent systematic reviews and pivotal studies were manually examined for any additional applicable literature. The initial search brought 532 potential sources. The selection and rejection standards were severe to provide that only the very best and most appropriate proof was utilized. The eligible studies published in the last five years (2020–2024) that evaluated the effectiveness, the ease, or the cost of using person-centered CBT and MI interventions in reducing readmission rates were considered. The researches should be on adults with opioid use disorder. Studies, which were not published in English, addressing demographics of children, or were of insufficient scientific rigor were excluded. Older sources were applied in cases of being extremely significant or unique and in relation to the project. System studies, government reports, and other related theses or dissertations were also included in the search approach to make it even broader. Applying those criteria and eliminating duplicates, 30 top selection sources were left for the literary combination. These sources were selected as they were sound methodologically, pertinent to the research question, and may provide useful information for formulating and using an individualized CBT and MI treatments for opioid-dependent individuals in a variety of healthcare settings.  

Analysis of Literature

Comprehensive review of all research that has been conducted on the PICOT question has been done. Thirty carefully selected sources, were scrutinized on their relevancy, the quality of analysis and how much they can help answer the study question. The sources were examined with the help of evaluation instruments, contemplating diverse perspectives and evaluating their dependability, excellence, and legitimacy. This review critically analyzed a number of previous studies on specific CBT and MI therapies for opioid-dependent patients and derived six main themes which provide an outline of the findings of that research. Here are some of these themes:Here are some of these themes:

The efficacy of Cognitive Behavioral Therapy (CBT) for Opioid Use Disorder (OUD) and chronic pain

Nowadays, many people pay attention to how effectively cognitive behavioural therapy (CBT) is when it comes to OUD and discomfort. The answers provided that 72% of the participants were in favor of CBT as the treatment of OUD because it professionally addresses psychological and behavioral problems that lead to this addiction. The participants reported that cognitive restructuring, behavioral activation, and relapse prevention were some of the most beneficial CBT techniques that guided individuals with OUD regarding coping and sobriety.

Cognitive restructuring and other CBT techniques allowed the patients to identify and question the thought patterns related to pain and drug use. They performed some useful activities with the help of behavioral activation techniques and their general functioning improved. The review also mentioned that CBT could make people more motivated to change and help them develop good ways of coping with pain eventually leading to less dependence on painkillers (White, 2023). They proposed the study plan for the EMPOWER trial by definition trying to test if the cognitive behavioral therapy (CBT) and the self-directed treatment of chronic pain are effective when the patients want to taper their drug use. Drug amount, pain level, and pain disability will be the primary outcome measures at 3, 6, and 12 months after the intervention. Some of the secondary aspects that will be studied in the research include quality of life, sleep and mental health.

The EMPOWER trial is designed to evaluate the effectiveness of cognitive-behavioral therapy (CBT) in assisting people to taper off of opioids and to improve pain-related outcomes relative to other all non-drug compared with all standard care. Wang et al. (2022)  state that the procedure of the study illustrates how CBT could make patients feel more in control of the pain and emphasize the need of using patient-centered approaches for tapering opioids. Research of Tucker et al. (2023) focused on the organisation of a cognitive behavior therapy (CBT) initiative based in primary healthcare for individuals with chronic pain who have been long-term users of painkillers. The findings revealed that integrating CBT into general care settings could be successful and was accepted by the professionals. Participants experienced superior outcomes of pain-related and less consumption of drugs. In the same way Tse et al. (2022) provide a detailed analysis of the evidence that proves CBT assists individuals with substance use disorders, encompassing OUD. The review concluded with unanimous evidence that CBT is effective in making an individual stop taking drugs and improve the psychological functioning. This demonstrates the flexibility of this method as a treatment.  

Motivational Interviewing for Opioid Misuse and Substance Abuse

One possible help for drug and opioid abusers has been motivational interviewing (MI). Studies (ICPsyche) (2023) had conducted much research on motivational questioning for drug abuse, including opioid use disorders. The research discovered that MI yielded a minor yet noteworthy impact on outcomes of drug use versus no treatment or treatment as usual. This suggests that MI may be effective as a brief treatment. Specifically, Starks et al. (2023) considered how brief motivational interviewing-based interventions could be utilized to assist in patients who abuse opioids in hospital settings. The writers emphasized that these therapies are feasible and appropriate and can be administered by different healthcare workers. They also discussed how they could reduce issues associated with opioids and increase the number of people attending treatment. Pinto e Silva et al. (2022) investigated the efficacy of minimal-intervention screening and brief intervention based on motivational interviewing for mild drug use in primary healthcare settings.

In the pilot randomized study, the participants who got the MI-based intervention reported significantly fewer drug use episodes as contrasted with those in the control cohort. This implies that MI may help in preserving the current condition of substance use problems. Pérula-Jiménez et al. (2024) developed an adjunctive model based on MI to treat this population with chronic pain and a drug use disorder. The writers discussed that MI approaches can be used in a context of a comprehensive treatment plan to motivate the clients in receiving pain management and drug recovery. Apart from Paul et al. (2023), in what way MI training influenced advanced practice nursing students’ attitudes and skills when managing prescription drug abuse was studied. This demonstrates the necessity of including MI education in training programs of healthcare professionals.

Implementation and Cost-Effectiveness of Minimal-Intervention (MI) and CBT Interventions

There has been several new researches that have been devoted to the cost and simplicity of applying MI and CBT to the people addicted to opioids and suffering from chronic pain. Nuria Romo Avilés et al. (2023) examined how much three different methods of using motivated questioning to assist drug abusers would cost and whether they would be cost-effective. The study revealed that the most comprehensive approach— one in where all employees were trained in MI and supervised—was the most successful in reducing drug use but also the most costly. When hospitals decide an implementation plan, the writers said they need to consider their objectives and the resources they have. Naar et al. (2023) systematically reviewed psychological treatment interventions that included MI and CBT, among others, used in outpatient drug treatment. The review emphasized the need to incorporate psychological methods into medication-assisted treatment, and outlined some of the difficulties in this regard – some of them were lack of personnel training and limited time.

Moreno et al. (2024) observed the efficacy of a program that combined motivational interviewing with controlled drug reduction among patients who were going to undergo a hip replacement. The pilot study was a randomized controlled trial and its results indicated that the intervention group had statistically fewer opioid users and better pain outcomes than the control group. This shows that MI could be useful to help surgery patients to quit their opiate use. Miller (2023) recommended a research design for a randomized clinical trial that aims at assessing efficacy of a computer-based cognitive-behavioral therapy (CBT) for treating dual diagnoses of chronic pain and addiction. At the onset, the study aims to establish whether the intervention is feasible, acceptable, and effective. The successful project will be amplified and it will be easy for patients with various conditions to use the services. Moreover, Magill et al. (2023) piloted a collaborative care intervention model that combined MI to reduce opioid harm and improve chronic pain control. The research showed that the intervention was successful, and both patients and doctors were satisfied with it. It also showed some benefit in reducing drug use and improving pain outcomes; therefore, supporting the potential efficacy of team-based approaches with MI.

CBT and MI for Concurrent Opioid Use Disorder and Mental Health Issues

Comorbid OUD and mental health such as worry and sadness make the therapy six to eight times harder. Lavilla-Gracia et al. (2023) conducted a study using the randomized controlled trials to evaluate the impact of a short cognitive behavioral treatment (CBT) treatment on the mental health of individuals with substance-related illnesses. The study revealed that short cognitive behavioral therapy (CBT) led to significant improvement in symptoms of sadness, anxiety, and stress compared to the control group. This underlines the possibility that CBT could target more than one psychiatric condition in those patients who are suffering from drug abuse. Karabatak (2023) also investigated the use of brief motivational interviewing (MI) to treat patients with opioid use disorder in hospitals, emphasizing the importance of addressing co-occurring mental health problems. The writes discussed on how MI methods can be used to make people more motivated to change and involved in full care for both drug and mental health issues. Ingesson Hammarberg et al. (2023) developed and tested a CBT protocol for the treatment of anxiety and OUD comorbidity.

The research discovered that a combination CBT approach may be functional and was acceptable to the participants. It also was found effective in reducing anxious symptoms and use of cocaine. According to Ibraheem Mhaidat et al. (2023) a study design for a pragmatic randomized controlled trial was suggested in order to compare cognitive behavioral therapy (CBT) and mindfulness-based therapy (CBT) for individuals with chronic low back pain on opioids. This research intends to evaluate the effectiveness of these strategies in pain control and reduction, along with opioid use and positive mental health outcomes, whereas it takes into account the convoluted connection between chronic pain, opioid use, and mental distress. Further, Hurlocker et al. (2023) explored the self-management of the overdosage of illegally used buprenorphine by individuals. This was a sign of how mental disorders lead to self-medication patterns. The study depicts the need of considering mental part of OUD and offer the accessible and comprehensive treatment options that include also psychiatric care.

Collaborative Care Models Incorporating CBT and MI

The approaches of integrative healthcare involving cognitive behavioral therapy (CBT) and motivational interviewing (MI) are considered as the most proper for opioid use disorder (OUD) and other related conditions by an increasing number of the population. The MI-CARE RCT was conducted by Tucker et al. (2023) and explored a patient-centered, nurse-led joint care program in primary care settings. The aim was to address depression and opioid use disorder (OUD) concurrently. The treatment method of the study included a nurse care manager who will follow guidelines to provide medication-assisted treatment for OUD along with behavioral activation techniques. The MI-CARE study is an initiative that involves multiple disciplines and is designed to be of help in patients with difficult problems, who have OUD and depression. In addition, Hotma Roiningsih Tambunan et al. (2023) developed the Subthreshold Opioid Use Disorder Prevention (STOP) trial, a cluster-randomized clinical trial that examines the influence of a collaborative healthcare intervention in decreasing hazardous opioid use or preventing primary care patients from developing moderate or severe OUD. STOP intervention involves brie advice of primary care physicians, nurse care management, and six telephone MI-based health advice calls. This entire strategy advocates early intervention and co-care notions that will prevent drug abuse from progressing.

To confirm the efficacy and cost effectiveness of CBT-based approaches (telehealth and online) is people with severe chronic pain, Hossam et al. (2023) devised the RESOLVE study protocol. The purpose of the research is to investigate whether these treatments, which are convenient and accessible, can deliver improved outcomes and decrease healthcare costs. This is the dynamic of technology-enabled joint accords that aim to deliver science-based solutions in a convenient manner. The collaborative RCT study design developed by Guo et al. (2023) the INSPIRE outlines that the effectiveness of shared decision-making and MI plus CBT is compared in people with chronic non-cancer pain in reducing the use of prescription drugs. The research demonstrates that the patient should be pulled towards the middle of his treatment and place psychological treatment that can lower drug use in the integrated care. The INSPIRE study explores the most effective strategy that helps one person to quit opioids also change their life by comparing different management strategies. Moreover, Charles et al. (2023) conducted a narrative review, which highlighted motivational interviewing in the treatment of cannabis use disorders. They discussed that it might work as short-term intervention in medical settings and that it may be integrated with other successful treatments, such as cognitive behavioral therapy (CBT). The review demonstrates the flexibility of MI when integrated as a central element of collaborative care models that help patients with different substance use problems to become involved and motivated to make changes.

Cultural Modification and Viability of CBT and MI

The cultural adaptation and implementation of CBT and MI treatments also become apparent that these processes are crucial for their efficacy and acceptability in different settings and to different populations. Adams et al.  in 2023 conducted extensive research on MI interventions for drug users.  The studies that were considered showed that motivational interviewing was efficacious for drug users in most studies. This points out the flexibility of the motivational interview in resource poor settings. Nevertheless, the authors of the study expressed that the ideal should be bigger sample sizes and more-focused design of the study for the improvement of the quality of the data and the potential sources of bias. Bourdon et al. (2023) further proposed a methodology for a feasibility factorial randomized controlled trial for the evaluation of culturally modified motivational interviewing, cognitive behavioral therapy, and mindfulness-based relapse prevention for individuals with drug use disorder. The study aims to learn whether these customized treatments are feasible, justified, and effective from the very beginning. It will clarify how the cultural context influences the manufacture and utilizations of psychology.

Boness et al. (2023) associated the counselor styles and individual characteristics of the recovering SUD counselors working at addiction treatment centers in New York, USA. In the qualitative study, the MI plus CBT proved to be one of the dominant therapies employed by the recovery counselors. These counsellors stressed the importance of using their own qualities and experiences to form powerful therapeutic alliances with clients. Moreover, the study demonstrates the role of psychologist’s training and attitudes in the implementation of MI and CBT therapies, especially in SUD treatment. The authors observed that additional research needed to establish the duration of effects; the efficacy of different interventions; and how the findings could be implemented with different populations and in differ settings. All these shows why the adaptability, to the particular culture and the practicality of the interventions aimed at implementing evidence-based practices, are important.

Further, Ayub et al. (2023) created and tested an integrated psychological modality that combines MI with cognitive behavioral therapy (CBT) for schizophrenic patients who have trouble sustaining their motivation. In a randomized controlled trial, the combined MI-CBT approach led to a significant reduction in depressive symptoms compared to the control condition of mindfulness. These changes were were still in place by the end of the follow-up. It is illustrated in the study that the techniques of MI and CBT could be adapted and mixture to help in some particular clinical issues and populations such as severe mentally ill. The authors talked about the possible consequences of such an issue for further investigation and how to provide the participations with the treatment benefits transfer to real life conditions. Here they showcase how important it is to take into consideration specific needs and details of the person being treated while planning and conducting psychological interventions.