Please respond to these 2 posts:
. Identify a problem in your clinical area. Choose a study from your research article search for your annotated bibliography assignment related to the clinical problem you identified. (These can be the same articles you found on your topic in week 2 but they must be individual studies and not expert opinion articles or a meta-analysis. )
The problem that I have identified is patients that require readmission to hospital after leaving the hospital against medical advice. These patients often present much more ill than they did the first time. There are also many cases where they had stayed in the emergency department, their condition could have been managed on an outpatient basis. By reducing wait time and increasing patients who stay until discharge from the emergency department, I hope to reduce readmission rates and decrease patient morbidity and mortality.
• In that research article:
o Did the study use a quantitative or qualitative approach?
o Identify the problem statement and purpose of the study.
o What are the research questions of the study? Explain the parts of the study question using the PICO acronym.
o What methodology was used to collect data?
The article I have selected to further explore from my annotated bibliography is “Discharge against Medical Advice (DAMA) from an Emergency Department of a Tertiary Care Hospital in Saudi Arabia by El-Metwally et al. Their research question examined the prevalence of discharge against medical advice in adult patients as well as what factors would predict if a patient would leave the department in this manner. The population examined was adults that presented to the King Abdullah Bin Abdulaziz University Hospital in Riyadh, Saudi Arabia between January 2017, and December 2018. The indication for inclusion in the study was being a patient in the department during the data collection period. There was no control group as this was an observational, retrospective study. The outcome was that gender and age interact to predict discharge against medical advice. Men over the age of 40 years old were significantly more like to discharge against medical advice than other populations. Acuity at triage also played a role with those triaged to the urgent care track also being more likely to leave against medical advice.
2. Create a well worded research question that relates to the problem you identified in your clinical area.
The research question I propose is “would follow up against medical advice discharges with a patient’s primary care provider reduce the representation and hospital admission rate of patients to my emergency department?”
3. Post your question along with the link to your research article into the forum and discuss how to improve/narrow/broaden your question. Help your fellow students by constructively using your thoughts/experience with the class in discussing their research questions.
As I continue my research, I may have to either broaden or narrow my question. I could look at specific conditions or patients that triaged at a certain ESI level. I also may want to look at the populations that leave AMA by age or race. Does time of day play a role? Is there a cut off of wait time that patients are willing to sit in the lobby for versus leave and try later?
El-Metwally, A., Alwallan, n. s., Alnajjar, A. A., Zahid, N., Alahmary, K., & Toivola, P. (2019). Discharge Against Medical Advice (DAMA) from an Emergency Department of a Tertiary Care Hospital in Saudi Arabia. Emergency Medicine International, 2019, 1-6. doi:10.1155/2019/4579380
A problem in my clinical area is how family members treat other family member with Substance-Use-Disorder (SUD) compared to other family members. The research on this topic will focus on understanding how a family members behavior and beliefs may impact those with SUD.
An ethnographic study analyzes family members experiences while supporting a family member with SUD. To answer the given research question, qualitative methods would be most appropriate to find an answer. As submitted by McCann, Polacsek, & Lubman (2019) the methodology “the data was collected, and analysis were guided by interpretative phenomenological analysis (IPA). Researchers using IPA draw on the principles of phenomenology and hermeneutics, as they seek to understand how individuals make sense of their lived experiences (22). This was done by interviewing family members on their experiences, feelings, behaviors. The questions in the McCann, Polacsek & Lubman (2019) study are: “What is it like to be the main support person in this situation? What effect, if any, has your relative’s AOD misuse had on your overall health and well-being? What effect, if any, has it had on your social and/or financial circumstances? What effect, if any, has it had on your family structure and/or dynamics, and how you support each other? What are the main things you do, if anything, to help you manage (cope) in your support-giving role? What things, if any, could improve your experience as the main support person? What things, if any, make it difficult for you to manage in your support-giving role?” (904).
In a meta-analysis, Little, (2016) summarized data from 4 types of therapy modalities. In a randomized control trial by Bonita et al. (2020) discusses the meaning of family is not the same for any two individuals. As a result of these findings they had to classify three sets of criteria around the meaning of family. A cohort study submitted by Houtepen et al. (2020) analyzed studies of children 1-16 years of age who has experienced a traumatic event. Santana & de Olivera (2017) reviewed cases of patients admitted to the hospital for SUD and some type of physical injury and the effects it has on other family members. The literature search consisted of qualitative research. In the future the studies could expand to include more on substance use disorder. The literature search was plentiful regarding the family interactions and mental illness and a few specifically on the topic SUDS and family interactions.
References
Bonita, S., Rohrbaugh, M. J., Audrey Cleary, Ferrer, E., Sbarra, D. A. (2020). Beyond the “self” in self-regulation: Family interaction modulates situational self-control by adolescent drug users. J Fam Psychol 34(3) 322-332.
Grummitt, L., Kelly, E., Barrett, E., Keyes, K. & Newton, N., (2021). Targets for intervention to prevent substance use in young people exposed to childhood adversity: A systematic review. PLoS One16(6), 1-30.
Houtepen, L. C., Heron, J., Suderman, M. J., Fraser, A., Chittleborough, C. R., & Howe, L.D. Association of adverse childhood experiences with educational attainment and adolescent health and the role of family and socioeconomic factors: A prospective cohort study in the UK.
PLoS Med 17(3) 1-22.
Liddle, H. A. (2016) Multidementional family therapy: Evidenced base for transdiagnostic treatment outcomes, change, mechanisms, and implementation in community settings. Family Process 55, 558-573.
McCann, T. V., Polacsek, & M., Lubman, D. I. (2019). Experiences of family members supporting a relative with substance use problems: a qualitative study. Scand J Caring Sci 33, 902–911.
doi: 10.1111/scs.12688
Santana, C. J. & de Olivera, M. L. (2017). Effects of drug involvement on long-term user’s family members. Rev Rene 18(5), 671-678.
