Introduction and Revised PICOT Question
Some of the considerable gaps during the evolution of healthcare include the management of chronic pain in patients that is, taking care of psychological factors causing pain catastrophizing. Chronic pain affects many people, thereby leading to a poor quality of life and an increase in healthcare costs. Most of the strategies of current pain management ignore psychological factors such as interpersonal issues and cognitive-behavioral factors that amplify patients’ experiences of pain. Addressing this gap, through targeted interventions incorporating CBT, might provide better management of chronic pain and lead to better outcomes for patients. As such, the PICOT question guiding this DNP project would be: In patients with chronic pain (P), does a cognitive-behavioral therapy intervention (I) compared with standard pain management approaches (C) reduce the level of pain catastrophizing (O) at six months (T)? This question essentially identifies the gap in practice and measures the effectiveness of psychological interventions in pain management and, therefore, contributes to better care strategies in clinical settings.
Critical Review of Literature
DeLeon, A. N., Peterson, R., Dvorak, R. D., Leary, A. V., Kramer, M. P., Burr, E. K., Toth, E. M., & Pinto, D. (2022). The health belief model in the context of alcohol protective behavioral strategies. Psychiatry, 86(1), 1–16. https://doi.org/10.1080/00332747.2022.2114270
DeLeon et al. (2022) examine college students’ health beliefs concerning alcohol use behavior, based on a focus on the protective behavioral strategy. The research questions are associated with the interaction between health beliefs, protective behavioral strategies, and alcohol consumption among college students. Research methods included a quantitative cross-sectional survey where the data was gathered from 250 respondents using a self-report survey. The study is anchored on the Health Belief Model, which ascribes a role to the perceptions of an individual in deciding health behavior choices. Applying the Johns Hopkins Evidence-Based Practice Model, the evidence is classified as level II given its quantitatively designed nature, but there are disadvantages in terms of self-report measures, and there may be some bias involved. There exist strong correlations between health beliefs and the use of protection strategies; therefore, it can be illustrated that the enhancement of perceived benefits and reduction of barriers might effectively reduce dangerous alcohol consumption. This would inform interventions aimed at improving alcohol-related behaviors among college students, possibly even including strategies relative to cognitive distortion in chronic pain management.
Ryum, T., Jacobsen, H. B., Borchgrevink, P. C., Landrø, N. I., & Stiles, T. C. (2019). Interpersonal problems as a predictor of pain catastrophizing in patients with chronic pain. Scandinavian Journal of Pain, 20(1), 51–59. https://doi.org/10.1515/sjpain-2019-0064
The paper by Ryum et al. (2019) examines the relationship between interpersonal problems and pain catastrophizing among chronic pain patients. A research question is addressed on how interpersonal issues may affect the level of catastrophizing on pain. It was a quantitative cross-sectional study that included 150 chronic pain patients in California. This study pivots around cognitive-behavioral theories, which suggest that interpersonal relationships play a very significant role in influencing the emotional and psychological processes associated with chronic pain. This review is graded as level II evidence using the SORT criteria as the variables are well-defined and suitable statistical analysis has been conducted. There is a high positive correlation found between interpersonal problems and pain catastrophizing, bringing under the focus the requirement for tailored interventions. The research article grants scope to discuss the assimilation of CBT techniques in dealing with interpersonal issues, thus improving patient outcomes concerning lowering levels of pain catastrophizing within chronic pain.
Clarke, V., Lehane, E., Mulcahy, H., & Cotter, P. (2021). Nurse practitioners’ implementation of evidence‐based practice into routine care: a scoping review. Worldviews on Evidence-Based Nursing, 18(3), 180–189. https://doi.org/10.1111/wvn.12510
The study by Clarke et al. (2021) performed a systematic review of the literature to assess nurse practitioners’ (NPs) implementation of evidence-based practice (EBP) and its influencing factors. The overall aim was to synthesize existing research on barriers and facilitators of EBP in primary care settings. The study drew on the thematic synthesis of 40 studies that managed to give a good snapshot of the literature. This conceptual model used was the Promoting Action on Research Implementation in Health Services (PARIHS) framework that is applied in the analysis of the implementation process. Grounded in the Johns Hopkins Model, appraised at level I, the paper pointed to practical factors and leadership to facilitate EBP. From the results, it appears that these are the hindrances that have to be addressed before there is increased NP involvement with EBP activities. This article will inform my project by saying that leadership training and resource allocation should be implemented in the manifestation of CBT interventions for chronic pain to ensure evidence-based practice helps in adding strategies into clinical practice.
Park, C. S. Y., Lee, S., Kim, H., & Kabak, M. (2022). Diffusion of innovations-informed knowledge translation strategy to implement optimal safe nursing workforce policy in practice. Florence Nightingale Journal of Nursing, 30(1), 92–99. https://doi.org/10.5152/fnjn.2022.21122
Park et al. (2022) explore the practice of workforce policies on safe staffing in healthcare organizations and emphasize successful policy implementation. The study aims to find out how knowledge translation impacts the implementation of a workforce policy. The qualitative case-study approach was employed; interviews were conducted with 15 respondents across the various health organizations in Canada. This research is founded on the Diffusion of Innovations Theory, which assesses the process that goes on within organizations in the stages of adopting new policies. It has undertaken appraisal based on GRADE, and it is categorized as level III evidence since its nature is qualitative and not generalizable. Findings suggest that leadership support and good communication are two critical factors to success, while challenges persist about resistance to change. Lessons that can be taken from this writing can find a place in the design of interventions to be directed at developing communication strategies and leadership support when implementing CBT for chronic pain management in a healthcare context.
Harris, M. T., & Rogers, W. A. (2021). Developing a healthcare technology acceptance model (H-TAM) for older adults with hypertension. Ageing and Society, 1–21. https://doi.org/10.1017/s0144686x21001069
Factors that determine acceptance of healthcare technology, Harris and Rogers (2021) assess what factors affect the acceptance of healthcare technology by older adults concerning the management of hypertension. The objective of the research was to determine what factors can predict older adults’ acceptance of technology. A cross-sectional survey design was used to collect information from 250 patients with hypertension. The Technology Acceptance Model (TAM) will provide the framework used in this study, focusing on perceived ease of use and usefulness as major determinants in technology acceptance. SORT criteria would classify the study as level II evidence, as it clearly describes the methodology and has properly applied its statistical analyses. The findings suggested that the implications of perceived ease of use and usefulness are very powerful predictors of technology acceptance among older adults, which emphasizes the need for user-friendly design. It provides a wide range of insights for designing interventions to enhance technology acceptance among older adults that will increase their involvement in CBT interventions to effectively manage chronic pain, which is likely to enhance health outcomes for the concerned population.
Synthesis of Literature
The studies reviewed above show that cognitively behavioral therapy-based interventions will be effective in managing chronic pains, minimizing catastrophizing, and enhancing coping resources. From the five studies reviewed, it becomes clear that understanding psychosocial factors, such as beliefs toward health, interpersonal issues, and the acceptance of technology, is critical for higher efficiency in pain management. For instance, beliefs regarding health will influence alcohol consumption behavior, as shown by DeLeon et al. (2022), and similar cognitive distortions may affect the coping mechanisms of chronic pain patients. In conjunction, Ryum et al. (2019) report that interpersonal problems and pain catastrophizing are interlinked; therefore, the success of CBT also depends on patients’ interpersonal contacts and relationships.
Additionally, Clarke et al. (2021) provided insight regarding the barriers and facilitators to nurse practitioners’ involvement in evidence-based practice, emphasizing the need for training and resource allocation for effective intervention implementation. This is complemented by Park et al. (2022), where it is shown that there is a need for effective policy implementation and leadership support to disseminate knowledge to practice within healthcare organizations. Finally, Harris and Rogers (2021) emphasize the role of perceived ease of use and usefulness in the technology acceptance model regarding the adoption of technology by older adults, which means that easily operated tools could involve patients more in CBT interventions. These articles together reflect the fact that management of chronic pain is a complex process and comprehensive interventions need to be implemented that integrate cognitive, social, and technological factors towards better outcomes for patients.
Evaluate the Quality of Literature
The five articles provided ample evidence that presents both strengths and weaknesses in the research. By far, the greatest strength is the diversity of methodologies used across the studies, which involves both quantitative and qualitative approaches. This diversity contributes to ensuring that knowledge gained is well-rounded about how CBT interventions may be tailored for different populations, such as college students and chronic pain patients. Additionally, most of the studies employ an established theoretical framework such as the Health Belief Model and Diffusion of Innovations Theory that add weight to the findings and enable an orderly interpretation of the data.
Also, there are weaknesses in the literature as well. First, samples from some studies such as those by Ryum et al (2019) could be weak in terms of generalizability due to small sample sizes or due to focusing on particular populations. Such would determine the applicability of findings in more general contexts. Additionally, while there is evidence showing psychosocial factors play an important role, there is limited comprehensive investigation about long-term effectiveness in various clinical settings for interventions designed from CBT.
Altogether, the strength of evidence is fairly moderate but lacks some areas. It is severely required to test if the introduction of technology to CBT interventions has an effect on older adults who are sometimes limited by barriers to the acceptance of technology. While available literature so far shows some benefits of CBT to the management of chronic pain, it may be worthwhile to investigate other treatments such as mindfulness-based stress reduction or interdisciplinary pain management programs.
Other unanswered questions include specific mechanisms by which social factors intervene to influence pain management outcomes and if different patient demographics (e.g., age, cultural background) influence the efficacy of interventions. There is also a need for further studies on standardizing protocols for implementing CBT interventions in healthcare settings so that they might be applied coherently across locations and produce a consistent impact on filling this gap in practice.
NURS FPX 8045 Assessment 6 Conclusion
The literature review thus underlines an acute need for effective interventions that bridge the gap in practice concerning the management of chronic pain and related psychosocial factors. Evidence gathered from studies across diverse works based on solid theoretical constructs revealed that interventions like CBT can help improve the management of pain significantly if aspects that are emotional and interpersonal are handled. Although the literature showed many strengths such as diverse methods, facilitators for implementing those interventions, and generalizability and long-term efficacy were not fully developed. Alternative interventions with the integration of technology into pain management strategies need to be explored, and further analyses of demographic variables are needed so outcomes can be maximized in the best way possible. Such findings can then be applied in targeted interventions by healthcare providers to achieve optimal management of chronic pain by patients and improvement of their quality of life.
NURS FPX 8045 Assessment 6 References
Clarke, V., Lehane, E., Mulcahy, H., & Cotter, P. (2021). Nurse practitioners’ implementation of evidence‐based practice into routine care: a scoping review. Worldviews on Evidence-Based Nursing, 18(3), 180–189. https://doi.org/10.1111/wvn.12510
DeLeon, A. N., Peterson, R., Dvorak, R. D., Leary, A. V., Kramer, M. P., Burr, E. K., Toth, E. M., & Pinto, D. (2022). The health belief model in the context of alcohol protective behavioral strategies. Psychiatry, 86(1), 1–16. https://doi.org/10.1080/00332747.2022.2114270
Harris, M. T., & Rogers, W. A. (2021). Developing a healthcare technology acceptance model (H-TAM) for older adults with hypertension. Ageing and Society, 1–21. https://doi.org/10.1017/s0144686x21001069
Park, C. S. Y., Lee, S., Kim, H., & Kabak, M. (2022). Diffusion of innovations-informed knowledge translation strategy to implement optimal safe nursing workforce policy in practice. Florence Nightingale Journal of Nursing, 30(1), 92–99. https://doi.org/10.5152/fnjn.2022.21122
Ryum, T., Jacobsen, H. B., Borchgrevink, P. C., Landrø, N. I., & Stiles, T. C. (2019). Interpersonal problems as a predictor of pain catastrophizing in patients with chronic pain. Scandinavian Journal of Pain, 20(1), 51–59. https://doi.org/10.1515/sjpain-2019-0064
