Critical Appraisal of the Evidence
First section Critical Appraisal of the Evidence. Based on your review of the literature, what is the current state of knowledge on this topic? What do we now know and what do we still need to know? What are the gaps in knowledge, and how does the current body of research contribute to the gap? How can future research fill the gap? Compare and contrast results and strengths and weaknesses of all 8 of the studies to determine what the research evidence supports or does not support. Do not repeat results from the third section. Typically, 2-4 paragraphs
2nd section Implications for Clinical/Managerial Practice. Based on the evidence, determine what the best practices are and make appropriate recommendations. In other words, how will you as a clinician or manager use the results of this literature review? These recommendations may include practice or cost implications. Usually Â½ page (Use Clinician standpoint).
Substance Use Disorder
Substance use is one of the epidemics facing most parts of the world. Substance abuse can be defined as a harmful pattern of using substances that leads to physical and mental problems. Some abused substances include alcohol, tobacco, illegal drugs, and prescription drugs. Substance use may contribute to failure in fulfilling major personal or general responsibilities, physical dangers and inabilities, and legal issues attached to the illegal use of the substances (Mumba 2018). Most scientists and focus on substance use among the lay population but less on professional workers, especially in the healthcare system. This paper will provide a critical appraisal of the evidence on the increasing prevalence of substance use disorder (SUD) among healthcare providers within the healthcare system.
Numerous studies have proven the increasing prevalence of substance use disorder among healthcare providers, including physicians and nurses. According to Mumba et al. (2019), about 3.1 nurses in the United States experience substance use disorder, a very high prevalence rate. Foli et al. (2020) estimate that the prevalence of substance use disorder among nurses ranges between 6% and 8% of the total number of nurses. This proves a high rate of substance use among healthcare providers, especially nurses. Kameg & Mitchell (2021) links the high prevalence of substance use among nurses with adverse childhood experiences. According to the research, nursing students with high levels of substance abuse were probably sexually or physically abused in their childhood. This evidence shows that adverse childhood experiences are one of the factors that contribute to the increased prevalence of substance use disorder among nurses. Mumba & Kraemer (2019) established more environmental factors that contribute to high levels of SUD prevalence among nurses apart from the ACEs discussed by Kameg & Mitchell (2021). According to the scholars, factors such as negative attitudes at the workplace, distressing environment, and high levels of access to substances as key factors that contribute to increased prevalence among healthcare providers, nurses. High levels of incivility and distressing working environment for the nurses increase the prevalence of SUD among nurses, and thus the interventions should be focused on reducing the factors. According to the study, exposure and easy access to drugs such as opioids increase the prevalence of abusing them, and thus the interventions should be focused on limiting their access.
The evidence also shows various barriers associated with self-reporting for the nurses with SUD within the healthcare system. Through a phonological study, cares et al. (2015) established that the barriers for self-reporting among nurses with SUDs included fear of being embarrassed and the fear of losing their license. Even though most of the nurses with SUDs cannot report their struggles with the condition, their colleagues find it difficult to identify the nurses with substance use disorder. According to Trinkoff et al. (2021), most RNs cannot recognize SUDs in their workplace. The researchers identify some nurses with SUDs, such as frequent medication errors, medication wastage, absenteeism, or frequent breaks from work. The authors, through the study, established that most nurses do not communicate with their supervisors for fear of being involved in the problem. This acts as a key barrier to addressing the issue of SUDs among nurses and other healthcare providers.
There are numerous gaps available in the evidence. The evidence provided in the meta-analysis does not provide evidence on the influence of peer pressure among nurses as a key contributor to the SUDs amongst the nurses. There is a need to establish the impact of peer pressure among the nurses in contributing to the high prevalence of SUDs among nurses by deducing how the nurses ended up with SUDs. Ineffectively countering the issue, there should be studies in establishing the relationship and the impact of nursing regulations and the prevalence of SUDs among nurses. Do the regulations and controls impact positively or negatively on the affected nurses? Mumba (2018) reports some of the impacts of restrictions on the nurses with SUDs, but the impacts are related to the workplace, such as increased workload for the unaffected nurses. This shows that new studies should focus on the effectiveness of the restrictive measures by states or individual organizations against nurses diagnosed with SUDs.
The strength of sources of evidence for the analytic research is that they are all primary sources of data. The data from the sources is collected from interviews, questionnaires, and other engaging strategies that would facilitate the sourcing of primary data. Primary data provides a strong source of evidence for nursing practice. The studies adopted cross-sectional and descriptive designs that effectively collect and analyze data in determining the relationship between the highlighted variables in both qualitative and quantitative research designs. The weaknesses of the evidence sources are that the participants were localized and positioned for high bias levels.
Implications for Nursing Practice
The evidence provides numerous factors related to the increased prevalence of SUDs among nurses, and thus key factors should be controlled in enhancing the prevention and control of substance use disorders among healthcare providers. One of the implications of the evidence is that providing a conducive environment with limited incivility and workplace distress may reduce the prevalence of nurses engaging in substance abuse. Incivility in the workplace may contribute to distress that pushes most nurses to substance use. Smiley & Reneau (2020) established that implementation and completion of the SUD program improve the behaviors of the affected nurses. This indicates that nurse managers should use strategies such as random drug tests, support group meetings, and psychiatric care to control the affected nurses’ issues. Creating a positive environment encouraging self-reporting and reporting of the colleagues involved in the substance use would provide an opportunity for early identification in control. Nurse Managers should thus encourage an environment that would increase the rate of self-reporting among the affected nurses, applying minimum restrictions and punitive measures.