MSN Capstone Project Proposal
MSN Program: Adult Gerontology Nurse Practitioner
Project Title: Effectiveness of Nurse Practitioner Training in Early Detection of Substance Abuse in Older Adults
Week 1
State Your Clinical Question
(150 Words)
State your clinical question or topic for your capstone project proposal.
What issue is the question/topic addressing?
What are the reasons you selected this question/topic?
References (2 or more within 5 years).
Substance abuse among older adults has been on the rise in the past years, wherein alcohol and prescription opioids are the common abuse substance among seniors (AAC,2022). The nurse practitioner’s role in the early detection of substance abuse among older adults is vital to the diagnosis and treatment. Substance abuse harms health, and detection delay might lead to death. The question is the effectiveness of nurse practitioner skills in screening improves early detection and treatment of substance use disorder among older adults. In addition, the question addresses delayed detection among older adults. The contributing factor to the delayed detection of substance use disorder among older adults is the lack of adequate education and screening skills for substance abuse among patients of advanced age (Jenkins et al.,2022). Therefore, I selected this topic to determine the effectiveness of nurse practitioners’ screening skills in the early detection of substance abuse among older adults.
Week 2
Background Information
(250 words)
Address the following questions/bullets in completing this section:
Start at the starting point – What, Where, When, Why, and How?
What is known about this topic or what is the evidence on this topic (Scoping Search)?
What is the outcome of interest?
What are the gaps in our understanding or knowing related to this topic?
Substance abuse is a growing health problem worldwide, with people across all age groups associated with substance use and abuse. In New Jersey, substance use affects both young and old populations, with the state recording high tobacco, alcohol, marijuana, and heroin use disorders relative to regional and national statistics. According to Seim et al. (2020), detecting substance use disorders among older adults is difficult due to the comorbidity with neurocognitive impairment, complicated medical conditions, and functional decline of the general body systems. The common symptoms of substance use among the elderly population include impaired judgment, risk of falls, impaired cognitive performance, and poor coordination. Various studies have proved that adequate patient screening education among nurses effectively improves the efficacy of healthcare providers in detecting and treating substance use disorders. Through a quasi-experimental study, Jenkins et al. (2022) established that providing continued education for healthcare practitioners on substance use disorders improves their capacity to screen, detect, and treat patients with substance use disorders. A similar study by Grainy et al. (2022) on the effectiveness of nurse training sessions on substance use screening efficacy showed an improved capacity to detect patients with substance use disorders. However, there is a gap in the impact of continued nurse education on their effectiveness in detecting substance use disorders early enough for treatment. The study’s anticipated outcome is that regular education workshops on effective screening techniques for substance use disorder among older adults improve the nurse practioner’s effectiveness in the early detection of substance use disorders.
Effectiveness of Nurse Practitioner Training in Early Detection of Substance Abuse in Older Adults- MSN Capstone Project Proposal
Week 3
Literature Search Strategies
[200 words]
Provide details of your exhaustive search process. Be certain to list:
- Databases searched.
- All the keywords or search phrases used.
- How many articles in total that were found?
- List the inclusion/exclusion criteria.
- Provide the number of articles that were retained and a description on why those articles were retained.
Consider using a flowchart to outline the search process.
Week 4
Literature Review
[1000 words]
Conduct a review of the literature. Include at least five (5) research articles and/or evidence-based guidelines. Address the following questions/bullets in completing this section:
- Conduct a review of the literature.
- Provide the highlights from the research.
- Synthesize the literature on the topic.
- Summarize how the project will contribute to knowledge by filling in gaps, validating, or testing knowledge.
Cite 5 references in this section per APA within 5 years.
EBP FOR QI – Conducting Literature Review, Create a Table of Evidence Fact Sheet Essay Sample
Substance use in older adults
Week 3
I searched PubMed, CINAHL, and Scopus for relevant articles to perform a thorough literature review. These databases make available an extensive collection of nursing and healthcare literature subjected to rigorous peer review. To begin my search, I used a combination of the following keywords and search phrases in my literature search: “substance abuse,” “older adults,” “nurse practitioner training,” “early detection,” and “screening.” The search phrases used were “substance abuse AND older adults AND nurse practitioner training,” “substance abuse AND older adults AND screening,” and “nurse practitioner training AND substance abuse screening. The initial search resulted in a total of 324 articles. After reviewing the articles for duplication and relevance, 60 articles remained.
This search was limited to articles published within the previous five years that examined the efficacy of nurse practitioner education in identifying signs of substance addiction in older adults. Non-peer-reviewed articles, articles written in languages other than English, and those that dealt primarily with substance addiction among young people were disqualified.15 articles were retained because they met the inclusion criteria and provided information on the effectiveness of nurse practitioner training in the early detection of substance abuse in older adults. The articles also provided information on different screening tools used by nurse practitioners in detecting substance abuse in older adults.
| Full text assessed for eligibilityN=105 | |||||||||||||||||||
| Retained studies (n=15)Studies included in review(n = 5) | |||||||||||||||||||
Literature Review and Highlights of the Research
The first article by Chang et al. (2019) investigates the effectiveness of MI training with standardized patient simulation for prescription opioid abuse among older adults. The study concluded that students benefited from the MI educational intervention regarding their understanding of and comfort with using MI. Student responses, however, suggested areas for enhancement and elucidated details that could be refined in future iterations of the intervention. The study’s results stress the value of simulation experiences for enhancing nursing students’ understanding of MI and preparing them for practice.
In addition, Gotham et al. (2019) discuss the implementation of substance use screening in family planning clinics. The research confirmed the obstacles and enablers to the CFIR paradigm of implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT). Many providers reported that they were not trained, had only received informal education, or knew of the procedure but not how to execute SBIRT to deal with substance abuse among women of reproductive age. It was noted by other professionals that physicians and staff need to work on their self-efficacy before they can ask patients about substance use or intervene effectively when they find out. Implementing SBIRT has been hampered by several obstacles, including time, money, administrative support, space, training, and resources. Increases in patient and staff access to resources and staff training and education opportunities were named as key enablers.
Moreover, Orciari et al. (2022) focus on MI-based interventions for reducing substance misuse and increasing treatment engagement, retention, and completion in the homeless populations of high-income countries. The review found limited research on MI’s effectiveness in changing substance misuse behaviors in homeless populations, focusing on short-term rather than long-term impacts. However, the results indicate that MI is more effective overall amongst adult homeless persons, yielding consistently small effects, and alcohol use behaviors seem more amenable to change due to MI/MET interventions than drug use ones.
Furthermore, Starks et al. (2022) examine the effectiveness of a combined motivational interviewing and cognitive-behavioral intervention to reduce substance use and improve HIV-related immune functioning. According to the study, the intervention successfully decreased substance use and enhanced participant immunological health associated to HIV. This study provides additional evidence for the efficiency of motivational interviewing as an intervention for treating substance use disorders.
Finally, Falise et al. (2022) focused on screening the “invisible population” of older adult patients for prescription pain reliever non-medical use and use disorders. The study indicated that various variables might contribute to low screening rates in older adult patients, including providers’ implicit biases and lack of training, time restrictions, and co-occurring disorders that mask NMUPPR and OUD-related symptoms. The study advocates for more emphasis on addiction in medical school curricula, CME courses on substance abuse, implicit bias education, and the elimination of walls between specialties such as pharmacy, geriatrics, addiction, and family medicine. This research emphasizes the importance of better screening and earlier diagnosis of substance use disorders in the elderly by increasing healthcare workers’ education and training.
Synthesis of the Articles
The literature review provides valuable insights into the challenges and opportunities for detecting substance use disorders in older adults. A common theme across the reviewed articles is the need for education and training of healthcare providers to improve the early detection and treatment of substance use disorders. The articles by Chang et al. (2019), Orciari et al. (2022), and Starks et al. (2022) all highlight the effectiveness of motivational interviewing (MI) and its combination with other interventions in reducing substance use and improving treatment outcomes. These studies emphasize the importance of training healthcare providers in MI to enable them to effectively apply it in their clinical practice. In addition, Gotham et al. (2019) identify several barriers and facilitators to screening for substance use disorders in family planning clinics, indicating the need for resources, training, and support for providers to enable effective screening. Moreover, Falise et al. (2022) focus on the issue of under-screening for substance use disorders in older adults due to providers’ implicit biases and lack of training. The article highlights the need for increased education and training for healthcare providers to improve screening and early detection of substance use disorders in older adults. The study recommends incorporating addiction-related curricula in medical schools and encouraging participation in continuing medical education training focused on substance use disorders.
Synthesizing the literature, the studies reviewed highlight the need for healthcare providers to have the necessary training and support to effectively screen and intervene for substance use disorders in various populations. MI emerges as an effective intervention in reducing substance use and improving treatment outcomes, combined with other interventions providing even better results. However, the studies also indicate the presence of barriers to effective screening and intervention, such as provider training, resource availability, and administrative buy-in. The literature thus calls for increased education and training for healthcare providers in substance use disorder screening and intervention and the provision of necessary resources and support for effective implementation.
Contribution to Knowledge
The project aims to address the gap in the impact of continued nurse education on their effectiveness in detecting substance use disorders early enough for treatment. The study anticipates that regular education workshops on effective screening techniques for substance use disorder among older adults improve the nurse practitioner’s effectiveness in the early detection of substance use disorders. The project’s contribution to knowledge will fill the gap in the impact of continued education on nurses’ effectiveness in detecting substance use disorders, thus improving the early detection and treatment of substance use disorders in vulnerable populations. This research will contribute to our understanding of evidence-based interventions for substance use disorders in at-risk populations by validating and testing the efficacy of frequent education workshops on effective screening approaches for substance use disorders among older persons. Finally, to further increase screening rates for older adults, the study will also contribute to knowledge on the value of including addiction-related curricula in medical schools and attending implicit bias training.
References
Chang, Y. P., Cassalia, J., Warunek, M., & Scherer, Y. (2019). Motivational interviewing training with standardized patient simulation for prescription opioid abuse among older adults. Perspectives in Psychiatric Care, 55(4), 681-689. https://doi.org/10.1111/ppc.12402
Falise, A. M., Sharma, V., Hoeflich, C. C., Lopez-Quintero, C., & Striley, C. W. (2022). Screening the “Invisible Population” of Older Adult Patients for Prescription Pain Reliever Non-Medical Use and Use Disorders. Substance Use & Misuse, 1-7. https://doi.org/10.1080/10826084.2022.2148483
Gotham, H. J., Wilson, K., Carlson, K., Rodriguez, G., Kuofie, A., & Witt, J. (2019). Implementing substance use screening in family planning. The Journal for Nurse Practitioners, 15(4), 306-310. https://doi.org/10.1089%2Fjwh.2020.8699
Orciari, E. A., Perman-Howe, P. R., & Foxcroft, D. R. (2022). Motivational Interviewing-based interventions for reducing substance misuse and increasing treatment engagement, retention, and completion in the homeless populations of high-income countries: An equity-focused systematic review and narrative synthesis. International Journal of Drug Policy, 100, 103524. https://doi.org/10.1016/j.drugpo.2021.103524
Starks, T. J., Skeen, S. J., Scott Jones, S., Gurung, S., Millar, B. M., Ferraris, C., … & Sparks, M. A. (2022). Effectiveness of a combined motivational interviewing and cognitive behavioral intervention to reduce substance use and improve HIV-related immune functioning. AIDS and Behavior, 1-15. https://doi.org/10.1007/s10461-021-03467-7
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