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Learning outcomes and their relationship to your course level outcomes can be found on the Postgraduate vUWS site.

Learning outcomes for the unit are outlined below.

1 Discuss the principles and processes of evidence-based practice.

2 Critically discuss the importance of individual patient preferences when making clinical judgments about the implementation of research findings.

3 Critically discuss barriers and facilitators to implementing evidence based practice in the clinical arena.

4 Conduct a comprehensive literature search on a clinical question.

5 Apply critical appraisal techniques to a range of research methodologies.

6 Critically appraise research for its application to practice.

Research Methodology

Substance use is a critical public health crisis that calls for dire attention (Krasikova, Lester and Harms, 2015). Substance abuse remedies play a significant role in minimizing the symptomatic effects associated with recurrent use of drugs. According to O'Leary?Barrett et al. (2017), persistent substance users are faced with clinical and functional impairments as well as alterations in their abilities to accomplish societal functions. Researchers and practitioners dealing with drug addicts have strived to advance proper ways of fostering improvements in the processes of delivering effective services (Neger and Prinz, 2015). Despite the efforts adopted, Yang, Perkins and Stearns (2018) reveal that premature dropout among the targeted populations is considered to be the greatest impediment to effective adoption of the therapeutic initiatives se to target drug addicts.  For instance, Sullivan, Messer and Quinlivan (2015) report that inpatient rehabilitation programs encounter dropout rates ranging between 20% and 70% with the first month being considered as a critical period and determinant of the efficacy of the treatment initiatives put in place. As a consequence, Yang et al. (2018) establish a research aimed at investigating the factors that act as facilitators and barriers to effective treatment of inpatient substance use clients. The current study applies the consolidated criteria for reporting qualitative research (COREQ) to analyze the article by Yang et al. (2018).

The study was conducted by three researchers; Yang Yang, David R. Perkins and Elizabeth Sterns. Yang and Perkins are assistant and associate professors of Psychology at the University of Louisiana at Lafayette. On the other hand, Elizabeth Stearns is an assistant professor in the Department of Criminal Justice at the University of Louisiana at Lafayette. While Yang and Stearns are females, Perkins is a male. Elizabeth Stearns boasts of her long   research interests in Corrections as well as Women & Criminal Behavior and Feminist Criminology. The fact that the three researchers share a similar workplace reveals that their relationship was established before the commencement of this study. The participants carried out the research to foster the advancement of knowledge and to contribute to the advancement of clinical practice when dealing with substance use clients.

The study established by Yang et al. (2018) proceeds with the aim of exploring the factors that impede or expedite short-term treatment inpatient treatment programs among clients exposed to substance use. To attain the desired levels of effectiveness, the scholars adopted a thematic analysis to evaluate the barriers and facilitators of treatment among inpatients seeking substance abuse remedies. The scholars’ move to analyze crucial organizational factors such as inadequacies in the treatments offered, the inability of these institutions to include remedies and infrastructure that are gender responsive and poor communicational strategies adopted by the nonclinical members of staff acts as an eye opener to players such as hospital administrators and physicians to uphold organizational cultures that aimed at fostering positive collaborations and teamwork. Similarly, the study acts as an operational blueprint aimed at facilitating the efficacy of caregivers working with patients suffering from substance use disorders in strengthening the institutional activities that facilitate treatment engagements through peer inspiration as well as the trust and affinity among the physicians.

Data Analysis

Yang et al. (2018) adopt a qualitative approach based on thematic analysis to investigate the factors that act as treatment impediments and facilitators among inpatient substance use clients. According to Lewis (2015), qualitative approaches play an effective role in demystifying the possible causes of the challenges faced by patients in clinical settings based on their optimal levels of efficacy in fostering explorations that depict higher degrees of patient centeredness. Similarly, Bryman (2017) commends qualitative approaches due to their inherent abilities in availing recovery experiences that embrace higher degrees of validity.

Thematic analysis was applied to foster the advancement of the premises on which the study would be anchored. According to Rauch, van Doorn and Hulsink, W. (2014), thematic analysis is one of the most effective instruments of fostering the processes of analyzing qualitative data. Similarly, Cresswell and Cresswell (2017) applaud this approach based on its higher levels of efficacy in allowing the researchers to gather systematic information and knowledge concerning certain designated situations, institutions and cultures. On the other hand, Braun, Clarke and Terry (2014) demystify that the thematic approach guides scholars by narrowing their investigations from a broader viewpoint of data while moving towards a narrow emphasis of the information collected based on a certain specified research question.

An analysis of the methodological approach applied by Yang et al. (2018) reveals the scholars’ effectiveness in moving from a broader substance use perspective to a narrower research question that is aimed at establishing the impediments and facilitators to treatment among substance use inpatients.  Further, the strength of the thematic approach adopted by the researchers emanates from their inherent abilities to adopt and apply coding. According to Braun and Clarke (2014), coding does not only allow the researchers to implement modifications in qualitative studies in ways that are iterative and explicit but also play a critical role in revealing the qualitative wealth of the phenomenon under investigation. Similarly, Braun and Clarke (2016) demystify that the codes adopted in thematic analyses form the bases of the themes that are analyzed by the researchers.


In their study, Yang et al. (2018) adopt a sample of 60 male participants. One of the greatest strengths reveal by the composition of the respondents used in the investigation is the ability of the scholars to recruit based on multiple characteristics. According to Bryman (2017), adoption of a sample space comprising of multiple characteristics plays an essential role in broadening the topic of study based on the variations in viewpoints.

Results

The site of the research was an inpatient public funded treatment initiative conducted in association with the Sheriff’s Office in one of the mid-sized city located in the southern part of the United States of America. The participants in this study were classified based on their racial boundaries, marital statuses, number of children, educational attainments and history of incarceration. However, the weakness of the sample used for this study emanates from the fact that the scholars only adopted male participants. There are tendencies that inclusion of a population comprising of female and transgender participants would yield different results. On the other hand, the sample size (n = 60) was a bit narrow to guarantee higher levels of validity and reliability of the results obtained. Similarly, Creswell and Creswell (2017) explain that a smaller sample size limits the efficacy of a study to be used in making generalizations. The fact that the scholars did not embrace distinct inclusive and exclusive criteria when recruiting the participants reveals its weakness. There are tendencies that some of the respondents adopted for the scholarly work may not have met certain set policies and guidelines set to underscore clinical investigations.

The scholars adopted interviewing as the major primary method of collecting data. One-on-one semi structured interviews were implemented to recruit eligible participants for this research. An analysis of the procedure adopted to collect data for this study reveals some levels of inefficiencies. For instance, the one-on-one and face to face interviews adopted by the scholars are time consuming (Creswell and Creswell, 2017). Such a position explains why the sample space used in the study was limited (n = 60).  There is need for future studies to adopt other methods of collecting data such as the use of structured questionnaires. According to Bryman (2017), questionnaires are not time consuming and are not bound the geographical challenges revealed by interviews. On the other hand, the fact that questionnaires may be applied for a larger population would increase the levels of validity and reliability of the results arrived at.

Coding was used to facilitate the processes of data analysis. The transcripts obtained during the interview were loaded into the ATLAS.ti software following the de-identification procedure. According to Braun and Clarke (2014), coding in thematic analysis plays a significant role in fostering the modifications of the information collected as ideas emerge. Similarly, Braun and Clarke (2016) reveal that the kind of codes adopted in a study form the bases of the themes to be investigated by the scholar.  The fact that the coding procedure adopted by Yang et al. (2018) meets the aforementioned properties reveals the efficacy of the data analysis procedure implemented.

Braun and Clarke (2014) demystify that the codes adopted in hematic analysis need to be audited by multiple agencies as a way of fostering integrity and minimizing the effects of biases that may result from including a single researcher. According to Braun and Clarke (2016), adoption of multiple analysts ensures the availability of adequate resources to read and re-read the data; initiate double checking of the information gathered as a way of instilling higher levels of validity and consistency. The study enhanced the levels of effectiveness of the analysis procedure adopted by recruiting three authors to participate in the process of coding. Further, the researchers adopted multiple strategies aimed at fostering qualitative analysis. For instance, the philosophies of thematic analysis and interpretive phenomenology analysis were put in place to foster optimal degrees of reliability. The coding procedure was brought to a halt after the three authors adopted for this study had reached an agreement on the specific codes to be adopted for thematic analysis.

Following the analysis conducted by the scholars, four primary themes were considered. Peer inspiration, perceived treatment needs, organizational barriers and trust and counselor rapport were considered as the major facilitators and barriers to effective treatment engagement encountered by inpatients seeking remedies for substance abuse in the clinical settings identified by the scholars. The significance of treatment motivation among clients suffering from substance abuse was considered as a key facilitator to the recovery initiatives put in place in inpatient settings. Pertinent issues such as motivating the clients each time they take the efforts of complying with the clinically recommended remedies was considered as a key facilitator to the process of healing. On the other hand, the inability of the affected individuals to recognize the availability of the problems they are facing was considered as a core barrier to the procedures set. Therefore, the aforementioned results reveal the importance of including client-centered motivations as a way of advancing effective treatments among substance use inpatients.

Life events were found out to play an essential role in compelling substance use patients towards seeking effective remedies in clinical settings. According to Yung, Eickhoff, Davis, Klam and Doan (2015), some individuals do not comprehend the adverse effects of the substances they consume at their early stages of life. However, understanding is established as the patients are exposed to different scenarios and experiences in life emanating from the psychological, social and health related risks associated with the substances they were initially exposed to. Consequently, the study established by Yang et al. (2018) is in line with traditional findings as it highlights on the importance of adopting age appropriate interventions when fostering treatments. Similarly, the researchers reveal that counselor rapport and peer inspiration act as critical contributors to the remedies adopted to target substance users. According to Winters et al. (2018), the empathetic relationships established between the patient and the counselors are highly effective in compelling the client towards seeking the desired medical attention. However, organizational factors were considered as essential barriers in the process of fostering treatments among addicts. Issues such as the unavailability of treatments that depict higher degrees of gender responsiveness and the ineffectiveness of practitioners in availing the opportunities needed to foster treatment discussions were considered as critical institutional impediments to effective adoption of the desired remedies. While the study avails conclusive findings concerning the promoters and barriers to effective treatment of these patients, it fails to reveal the effects of personal, social and psychological factors in these procedures. As a consequence, future studies need to underscore the efficacy of these factors in fostering treatments.

Conclusion

The study aimed at investigating the factors that act as facilitators and barriers to effective treatment of inpatient substance use clients. To achieve the desired results, the researchers adopted a thematic analysis to evaluate the barriers and facilitators of treatment among inpatients seeking substance abuse remedies. Peer inspiration, perceived treatment needs, organizational barriers and trust and counselor rapport were considered as the major facilitators and barriers to effective treatment engagement encountered by inpatients seeking remedies for substance abuse in the clinical settings. The results of this investigation contribute to the nursing profession by acting as an eye opener on the need for stakeholders to adopt patient centered remedies aimed at fostering the advancement of clinical environments that promote inclusivity when dealing with substance use patients.

References

Braun, V., & Clarke, V. (2014). What can “thematic analysis” offer health and wellbeing researchers?. International journal of qualitative studies on health and well-being, 9.

Braun, V., & Clarke, V. (2016). (Mis) conceptualising themes, thematic analysis, and other problems with Fugard and Potts’(2015) sample-size tool for thematic analysis. International Journal of Social Research Methodology, 19(6), 739-743.

Braun, V., Clarke, V., & Terry, G. (2014). Thematic analysis. Qual Res Clin Health Psychol, 24, 95-114.

Bryman, A. (2017). Quantitative and qualitative research: further reflections on their integration. In Mixing methods: Qualitative and quantitative research (pp. 57-78). Routledge.

Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications.

Krasikova, D. V., Lester, P. B., & Harms, P. D. (2015). Effects of psychological capital on mental health and substance abuse. Journal of Leadership & Organizational Studies, 22(3), 280-291.

Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), 473-475.

Neger, E. N., & Prinz, R. J. (2015). Interventions to address parenting and parental substance abuse: Conceptual and methodological considerations. Clinical psychology review, 39, 71-82.

 O'Leary?Barrett, M., Masse, B., Pihl, R. O., Stewart, S. H., Seguin, J. R., & Conrod, P. J. (2017). A cluster?randomized controlled trial evaluating the effects of delaying onset of adolescent substance abuse on cognitive development and addiction following a selective, personality?targeted intervention programme: the Co?Venture trial. Addiction, 112(10), 1871-1881.

Rauch, A., van Doorn, R., & Hulsink, W. (2014). A Qualitative Approach to Evidence–Based Entrepreneurship: Theoretical Considerations and an Example Involving Business Clusters. Entrepreneurship Theory and Practice, 38(2), 333-368.

 Sullivan, K. A., Messer, L. C., & Quinlivan, E. B. (2015). Substance abuse, violence, and HIV/AIDS (SAVA) syndemic effects on viral suppression among HIV positive women of color. AIDS patient care and STDs, 29(S1), S42-S48.

 Winters, K. C., Botzet, A. M., Stinchfield, R., Gonzales-Castaneda, R., Finch, A. J., Piehler, T. F., ... & Hemze, A. (2018). Adolescent substance abuse treatment: A review of evidence-based research. In Adolescent Substance Abuse (pp. 141-171). Springer, Cham.

 Yang, Y., Perkins, D. R., & Stearns, A. E. (2018). Barriers and Facilitators to Treatment Engagement Among Clients in Inpatient Substance Abuse Treatment. Qualitative health research, 1049732318771005.

Yung, K., Eickhoff, E., Davis, D. L., Klam, W. P., & Doan, A. P. (2015). Internet addiction disorder and problematic use of Google Glass™ in patient treated at a residential substance abuse treatment program. Addictive behaviors, 41, 58-60.

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