[Sharon]

Theory and Framework Reflection (Maximum 250 words)

Pick a framework or theory discussed in this course. Write a discussion post on how your research problem fits into that framework? Why did you pick this framework or theory? How might this framework help answer your research problem?

Part 2: Comment on one of your peer’s posts. (Maximum 250 words) • Ask a clarifying question • Offer a different perspective • Share your reflections or describe how your experiences relate to the theory or framework.

[Paula]

How do adverse childhood experiences (ACEs) influence subsequent opioid misuse behaviour? Utilizing the social determinants of health framework for research, I have chosen this approach because of its exploratory nature and flexibility (less prescriptive), as indicated by the assigned reading material. This framework acknowledges the influence of diverse factors, such as social, economic, environmental, and cultural elements, on health outcomes (Government of Canada, 2023).

Environmental factors, including family structure and protective measures, play a crucial role in mitigating or exacerbating the impact of ACEs and mental health on opioid misuse behaviour (Government of Canada, 2024). Social factors, encompassing healthcare access and societal attitudes, are also influential. For example, a lack of mental health support may contribute to an increased likelihood of opioid misuse. Additionally, societal stigma and discrimination, something that I have experienced among the public and other healthcare professionals, can affect parental engagement in opioid misuse or treatment-seeking behaviours.

Economic considerations, such as poverty and education, further contribute to the issue’s complexity (Government of Canada, 2023). Research employing this framework can delve into how economic stressors may impact maladaptive coping mechanisms, thereby increasing the probability of opioid misuse. Exploring the relationship between educational levels and ACEs can provide insights that inform prevention strategies, influencing child welfare policies and legislation.

Utilizing the social determinants of health framework, researchers can gain a more comprehensive understanding of the multifaceted factors shaping the association between ACEs and subsequent opioid misuse. This comprehensive approach can facilitate interventions and inform policies that address ACEs and opioid misuse.

https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

[Victoria]

Hi Paula,

Thank you for your post! I agree the SDOH framework can serve as a valuable tool to gain a more comprehensive understanding of the multifaceted factors shaping the relationship between ACE’s and opioid use. I’m curious to know if you have encountered any specific studies or evidence that delve deeper into the protective measures within family structures? Particularly those effective in mitigating the impact of ACEs on opioid misuse. I appreciate your emphasis on economic factors as it aligns with the issues complexity and gives insight into how economic stressors can contribute to opioid misuse. I think this a great area to further research and appreciate your interest in it. Thanks again!

Victoria

[Paula]

Hi Victoria,

I appreciate your insights in your response. I share your interest in exploring protective factors that could potentially alleviate or mitigate the negative outcomes linked to Adverse Childhood Experiences (ACEs) and subsequent opioid usage. From what I’ve gathered anecdotally, patients dependent on opioids often highlight that unstable and stressful family environments tend to increase the likelihood of unhealthy coping strategies.

A quick glance through the scholarship underscores the importance of parent education, robust social support networks, and access to resources within the family framework as protective factors. It seems that focusing on these areas could hold promise for addressing the challenges posed by ACEs and their potential link to opioid misuse.

Thank you for engaging in this important discussion!
Paula

[Jennifer]

Hi Paula,

Your research question certainly poses a very crucial question. The challenges involved with opioid misuse are so complex and the valuable research into ACE’s and the potential for prevention is so important. Highlighting areas that are lacking in our health care system such as mental health supports and recognizing the societal stigma that is present shows the impact that the community and society as a whole plays in this health crisis. In my experience in primary care the need for counselling and mental health services is in such high demand for our youth and unfortunately, the waitlist for publicly funded access only continues to increase which further widens the socio-economic divide and calls to attention the urgent need for a mental health strategy that will increase access to care for all.

Jennifer

[Sasha]

This is an interesting topic! Have you found specific interventions that have been proven to be effective In addressing ACEs throughout the research in the context of the social determinants of health?

Acknowledging the wide and varied influence of social determinants of health on ACEs and opioids use how do individual resilience factors for example social support networks or access to mental health resources to mitigate the negative impacts of ACEs on opioid use?

[Victoria]

To review, my research question is focused on the use of a preoperative admission checklist (intervention) for nursing staff to improve the number of operating room patients receiving preoperative prophylactic antibiotics on time.

To pick a theory/framework for my research problem, I went to the literature to identify what other frameworks and theories have been used by researchers to answer a similar type of research question. I was able to find a handful of theories and frameworks that have been used by various researchers when it comes to the implementation of a surgical safety checklist, which is a similar concept to the implementation of a preoperative admission checklist. The theory/framework I found within my search that I believe is applicable to my research question is the Normalisation Process Theory (NPT).

NPT is a middle-range theory that is valuable for identifying factors that either facilitate or hinder integration of an intervention into clinical practice (Gillespie & Marshall, 2015). It is useful for explaining the function of an intervention not only during the initial stages of implementation, but also as it becomes integrated into clinical practice (Gillespie & Marshall, 2015). The four components of Normalization Process Theory include: coherence (sense-making), cognitive participation (engagement), collective actions (actions facilitating intervention implementation), and reflexive monitoring (Gillespie & Marshall, 2015). To effectively embed a practice and normalize it into routine work patterns, it is essential to understand the activities and work processes of health professionals, providing insights on how such practices can be sustained (Gillespie & Marshall, 2015).

In my research questions, this theory serves as a valuable framework for understanding and evaluating the implementation of a preoperative admission checklist into the daily work of healthcare professionals (nurses). NPT will aid in assessing the ongoing sustainability (integration) of the checklist intervention in clinical practice. It will also help identify factors that facilitate or hinder the checklist’s integration into practice. NPT’s four components can guide us in comprehending how nurses perceive, engage with, and embed the preoperative admission checklist into their routine nursing practice/work patterns.

References

Gillespie, B. M., & Marshall, A. (2015). Implementation of safety checklists in surgery: A realist synthesis of evidence. Implementation Science, 10(1). https://doi.org/10.1186/s13012-015-0319-9

[Paula]

Hi Victoria,
As someone who’s dedicated much of my career to mental health, I’m not as familiar with your practice setting, but I’m genuinely intrigued by your research question! While I may not have initially grasped its importance, I can see how using a preoperative admission checklist for nursing staff to ensure the timely administration of prophylactic antibiotics is vital. It’s all about promoting patient safety, sticking to evidence-based practices, and continuously improving perioperative care.

In my early nursing days, I quickly learned the importance of cautious antibiotic use to minimize resistance and potential adverse effects. That’s why healthcare providers carefully weigh the need for prophylactic antibiotics based on individual patient factors and evidence-based guidelines.

I’m curious—are there other reasons driving your exploration of this research question? I’d love to learn more!

Kindest regards, Paula

[Victoria]

Hi Paula,

Thank you for your response and engaging! My patients remain at the centre of my exploration into this topic for the reasons you have so nicely summarized, it comes down to safety, quality-improvement, and overall sticking to evidence-based practice to ensure the best outcomes for our patients.

Victoria

[Jennifer]

How can providers reduce parental vaccine hesitancy towards childhood vaccination?

After researching similar literature on vaccine promotion using different communication strategies, I came across the RE-AIM framework. This led me to learn about the framework and ultimately choose this framework to help evaluate and assess my research question.

RE-AIM was originally developed as a framework for consistent reporting of research results and later used to organize reviews of the existing literature on health promotion and disease management in different settings. The acronym stands for Reach, Effectiveness, Adoption, Implementation, and Maintenance which together determine public health impact. (RE-AIM, 2024). The framework has also been used to understand the relative strengths and weaknesses of different approaches to health promotion and chronic disease self-management-such as in-person counseling, group education classes, telephone counseling, and internet resources. (RE-AIM, 2024)

For the purposes of my research question, the RE-AIM framework can be used to help evaluate different approaches to health teaching and identify what communication strategies are most effective in reaching vaccine hesitant parents, ultimately increasing the uptake of childhood vaccination. It can also be used to highlight what areas are being missed when communicating with parents by identifying and addressing what their concerns and fears are around vaccination. Additionally, it could help identify the need for further widening the reach of communication within the community as a whole.

What is RE-AIM?

[Author]

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