Critique of Nursing Research Article Exploring Drug Abstinence Following Behavioural Therapy

The article chosen to be critiqued is titled “Achieving Drug and Alcohol Abstinence Among Recently Incarcerated Homeless Women: A Randomized Controlled Trial Comparing Dialectical Behavioral Therapy-Case Management With a Health Promotion Program”. The abstract of the article is detailed and clearly outlines the different components throughout the article. The abstract written by Nyamathi et al. (2017), provides sufficient insight into the design of this study and enables the reader to build a clear of understanding of the issue being investigated.

Research Problem and Purpose

 The research problem is not clearly defined in this study, however, within the introduction the reader can infer the issue the authors intend to study. The problem presented within the introduction highlights the vulnerability of recently freed drug offenders to reengage in inappropriate drug use and succumb to homelessness, and the lack of necessary resources to provide adequate transition back into the free world. The study utilizes a specific behavioral intervention to tackle the issue of unmanaged drug abuse among homeless ex-drug offenders (Nyamathi et al, 2017). The purpose of this study is clearly defined. The main purpose compares the effect of the dialectical behavioral therapy vs. health promotion program on aiding homeless ex-drug offender successful eliminate use of drugs when released (Nyamathi et al, 2017).

Review of Literature

 This study identifies other literature sources that have utilize the dialectical behavioral therapy to improve outcome in patients with personality disorders. A study by Linehan et al., (2006) illustrated the effectiveness of dialectical behavioral therapy in suicidal patients. Another study highlighted in this article demonstrated that dialectical behavioral therapy can reduce impulsive aggressive behavior in female prisoner with bipolar disorder (Nee & Farman, 2005). The results of these two studies provides enough evidence that the use of dialectical behavioral therapy can successfully modify at risk behaviors.

Nursing Framework

 The nursing framework or theoretical basis is discussed within this study. The study utilizes the comprehensive health seeking coping paradigm to construct their experimental design and lead decision made throughout the study (Nyamathi et al, 2017). This theoretical model utilized factors such as sociodemographic, situational, and social to effectively study the impact of dialectical behavior therapy on ex-offenders (Nyamathi et al, 2017).

Research Questions or Hypotheses

 The hypothesis of this study is properly explained for this study. The researchers believe that the use of dialectical behavioral therapy correction –modified will work better at reducing use of drugs and alcohol in homeless female parolees when compared with the health promotion program (Nyamathi et al, 2017). The study also works to explore what initial determinants are necessary to achieve the goal of abstinence from drugs and alcohol (Nyamathi et al, 2017).

Research Variables

 Nyamathi et al, (2017) experimental study consisted of a variety of measureable variables. Variables measured included the sociodemographic and situational status which provided insight into the participants’ history (Nyamathi et al, 2017).  Other variables including social support, depression levels, anger and hostility were evaluated using specific scale measure described in study. Participants’ ability to cope were also evaluated and abstinence was evaluated by assessing participant’s urine and by receiving self-reporting (Nyamathi et al, 2017).

Study Design

 The study utilized a randomized controlled trial which included 130 female parolees/probationers with ages ranging from 19-64 (Nyamathi et al, 2017). Randomized controlled trials are noted to be the ideal study method for measuring effectiveness of an intervention (Grove & Gray, 2019). Also, the ability to reduce bias and error improves with randomized controlled trials. The study does not specify whether or not blinding was implemented so the risk for some bias can be present.

Population and Sample

 In this study Nyamathi et al. (2017) selected participants by screening homeless ex-offenders from four different community based sites. The potential participants were screened using specific criteria sampling discussed in the study that allowed Nyamathi et al. (2017) to obtain their sample size of 130 participants to undergo the experimental study. Additionally, a sample size of 130 should be sufficient to allow for confidence in results obtain from study.

Procedures

 The procedures in this study was adequately summarized. Nyamathi et al. (2017) details methods used to reach out to potential candidates which included the use of flyers and posters. Candidates then underwent criteria selection and then randomly designated to either the dialectical behavioral therapy group or the health promotion group (Nyamathi et al. 2017). Additionally, Nyamathi et al. (2017) details measures taken to ensure participation which included the use of monetary incentives.

Results

 A variety of data analysis measures were utilized to determine results.  The characteristics of participants were compared by utilizing the Pearson’s χ2 test or the Fisher’s exact test (Nyamathi et al. 2017). The dialectical behavioral therapy group and health promotion group effectiveness in reducing or eliminating drug/alcohol use in participants were measured utilizing logistic regression modeling (Nyamathi et al. 2017). Findings from this study show that that both groups led to some degree of abstinence, however, the dialectical behavioral therapy group did have greater increase in the degree of drug abstinence (Nyamathi et al. 2017). Additionally, the study found that the dialectical behavioral therapy group were more inclined to be alcohol abstinent as well.

Validity of Research

 Nyamathi et al (2017) discusses measurements methods used to analyze data. The use of dialectical behavioral therapy as a form of behavioral modification have also been supported by other studies discussed within this study which shows that reliability was used to properly form this study. The study overall participation/ completion percentage remain near to 90% for both groups. Additionally, the study addresses its own limitations which all speaks to the validity of this study.

Efficacy of the Study

 The study by Nyamathi et al. (2017) was a randomly controlled experiment which is ideal for limiting bias and speaks to the efficacy of a study. The interventions used in the study were able to be measured and provided sufficient data that allow conclusions to be drawn. Furthermore, the meticulous nature of selecting participants for this study speaks the efficaciousness of this study.

Legal and Ethical Issues

 The study by Nyamathi et al. (2017) indicates that it was approved by a University review board and registered with Clinical Trials.gov. Additionally, Participants in the study were provided with written consent forms which were obtained prior to inclusion into the study. Finally, the benefits of the study outweighed the risk because the ethical procedures used during the study protected the confidentiality of the participants and of the nurses and others involved in the study. This study was conducted in an ethical manner.

Cultural Aspects of Study

 The study by Nyamathi et al. 2017 does not explicitly speak to the cultural aspect of their study, however, in this study the culture of female prisoner is brought to light. The culture that leads to female prisoner developing self-harming drug and alcohol addiction is discussed within this study. Additionally, the studies use of the dialectical behavioral therapy works to disrupt the damaging effects of drug and alcohol use among homeless female ex-offenders. Nyamathi et al. (2017), mentions the potential for their study to have a cultural impact on races such as African Americans, Latinas, and Whites in future studies.

Research Impact on Future Studies

 Much of the nursing practice deals with providing patients with the capacity to take control of their health. Nyamathi et al (2017) study, manages to apply this aspect of nursing to a population of female ex-offenders struggling with drug and alcohol addiction. The components of this research can be applied to patients struggling with addiction to opioids and provide an intervention that grants patients the ability to retake control of their health. In this study, the researchers speak to cultural component that can be looked more closely and the need for larger sample sizes to further understanding and identify areas of improvement (Nyamathi et al, 2017).

Research Contribution to Nursing Student’s Practice

 As a nursing student, a number of interventions are studied to aid patients in achieving better health and improving health outcome. This study addresses the important area of behavior and how adequate behavioral therapy can modify individuals that have very complicated issues such as female ex-drug offenders. Knowledge acquired from this study can go a long way in adding to the toolbox of nursing students and greatly improve nursing practice as it pertains to behavioral modifications.

References

• Nyamathi, A. M., Shin, S. S., Smeltzer, J., Salem, B. E., Yadav, K., Ekstrand, M. L., . . .Faucette, M. (2017). Achieving Drug and Alcohol Abstinence Among Recently Incarcerated Homeless Women. Nursing Research, 66(6), 432-441. doi:10.1097/nnr.0000000000000249
• Grove, S. K., & Gray, J. (2019). Understanding nursing research: Building an evidence-based practice. St. Louis, MO: Elsevier.
• Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, … Lindenboim N. Twoyear randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry. 2006; 63:757–766. DOI: 10.1001/archpsyc.63.7.757 [PubMed: 16818865
• Nee C, Farman S. Female prisoners with borderline personality disorder: Some promising treatment developments. Criminal Behavior and Mental Health. 2005; 15:2–16. DOI: 10.1002/cbm.33