Safety and proven effectiveness remain the cornerstones of exceptional patient care and positive hospital experiences. Multiple models of evidence-based practice have been developed to reduce the research-practice gap in clinical settings and keep up with knowledge explosion. This paper discusses the potential uses of the ACE Star Knowledge Transformation model to address the internalized stigma of mental disease in racial and ethnic minorities and summarizes differences between EBP and clinical research.
Practice Problems and EBP Models
The practice problem in mental health care refers to the social and internalized stigma of mental illness within racial/ethnic minority communities. As per U.S. epidemiological research, minority communities, especially Latino Americans and African Americans, have a decreased likelihood of seeking/receiving mental healthcare services (Kreps, 2017). Social stigma (SS), which finds reflection in the spread of harmful beliefs that equate psychiatric diagnoses, including schizophrenia spectrum and mood disorders, to non-existent self-regulation or even an outcome of psychological flaws, is hypothesized as one of the key contributors to such mental health disparities (Eylem et al., 2020; Kreps, 2017). At the systems level, the various forms of SS lead to detrimental effects, including the internalization of destructive beliefs about one’s diagnosis, attempts to engage in self-medication, and ill-considered treatment refusal decisions (Eylem et al., 2020; Kreps, 2017). In both inpatient and outpatient settings, internalized stigma is conducive to decreases in self-esteem, perceived self-efficacy, and adherence to medication regimens in racial minorities (Rossi et al., 2017). From the practical viewpoint, the challenges above may highlight the need for routine screening for internalized stigma and anti-stigma psychosocial treatments for minority patients.
The theoretical model that would best support the stated problem’s exploration is the ACE Star EBP model. The “star” represents a five-stage process of transforming knowledge from new research into updated clinical guidelines and posits that careful data reviews and efforts to classify and systematically evaluate the available evidence are obligatory (Indra, 2018). The key reason for giving preference to the ACE Star model is that it is intended for the safe and effective systematization and transformation of disparate pieces of evidence into viable care guidelines (Indra, 2018). Other popular stepwise frameworks, including the Advancing Research through Close Collaboration (ARCC) model, facilitate the establishment of clinical environments that are receptive to the previously developed EBP solutions (Indra, 2018). In mental health clients, especially narrow populations, such as ethnic/racial minority psychiatric inpatients, effective hospital-level interventions to detect and address internalized stigma have not been researched extensively (Eylem et al., 2020). It results in a lack of definitive anti-stigma solutions to be implemented by means of the ARCC or similar models.
The ACE Star approach to EBP would effectively support further research endeavors and prevent the implementation of methodologically weak, poorly generalizable, and biased evidence. Two potential barriers to addressing the practice problem include both the scarcity of anti-self-stigma intervention studies in minority patients and the existing trials’ heterogeneity in terms of statistical power (Büchter & Messer, 2017). The effectiveness of currently known strategies, including group-based narrative enhancement/cognitive therapy interventions and education via handouts, for self-stigma reduction remains an open question, and methodological diversity also adds to uncertainty and illustrates the need for the level of evidence classifications (Büchter & Messer, 2017). Based on the selected model’s underlying premises, systematicity in the ACE Star promotes the generation of unbiased practice improvement suggestions, which will ensure the use of strict evidence selection schemes (Indra, 2018). Taking significant knowledge gaps in the practice problem into account, this model could be the least risky approach to exploring hospital-based strategies peculiar to protecting vulnerable populations from self-stigmatization’s effects.
EBP and Clinical Research: Differences and DNP-Prepared Specialists’ Roles
Clinical research and EBP are notably different in terms of the nature of produced information. Research is involved in the generation of new knowledge about treatments, medications, and care strategies, whereas EBP is centered on converting such takeaways into improved guidelines. Clinical research refers to research endeavors that add new pieces of evidence to the existing body of medical and nursing knowledge, thus updating, weakening, or reinforcing previously identified tendencies peculiar to particular treatments’ contributions to health outcomes and health restoration speed. In my area of practice, adult and geriatric mental health, clinical research may involve biomedical trials and double-blind studies for psychotropic and antipsychotic drugs, psychotherapy research, or hospital-based studies of strategies to improve nurse-patient interaction by reducing patient violence and improving risk assessment procedures. Instead of stressing knowledge development and evidence generation, EBP facilitates the translation of existing evidence into everyday practice, for instance, the adoption of new types of cognitive-behavioral therapy or exposure therapy. Therefore, the two modes of promoting high-quality care lead to dissimilar takeaways and differ in scope.
DNP-prepared nurses can play a variety of roles in both EBP and clinical studies. Since EBP goes far beyond evidence implementation and involves the application of individual clinical expertise and patients’ decisional needs, doctorally-prepared nurses can use their vast clinical interaction experiences to sustain EBP culture and maintain the right balance between evidence from research and patients’ individual factors and preferences. As for clinical research, a doctoral degree primarily enables a nurse to become a full-fledged quality improvement initiator and participate in the coordination of clinical studies in collaboration with other clinical professionals. Importantly, both forms of professional activity provide invaluable career and knowledge progression opportunities.
Conclusion
Finally, theory plays an essential role in both research and practice. By giving the pride of place to evidence evaluation, the ACE Star EBP model could be helpful in researching anti-stigma interventions to assist minority patients with mental health diagnoses. Although the ultimate goal of both EBP and clinical research is to cause improvements to healthcare clients’ subjective and objective well-being, they have different priority areas.
References
BĂĽchter, R. B., & Messer, M. (2017). Interventions for reducing self-stigma in people with mental illnesses: A systematic review of randomized controlled trials. GMS German Medical Science, 15, 1-12.
Eylem, O., de Wit, L., van Straten, A., Steubl, L., Melissourgaki, Z., Danışman, G. T., de Vries, R., Kerkhof, J. F. M., Bhui, K., & Cuijpers, P. (2020). Stigma for common mental disorders in racial minorities and majorities: A systematic review and meta-analysis. BMC Public Health, 20, 1-20.
Indra, V. (2018). A review on models of evidence-based practice. Asian Journal of Nursing Education and Research, 8(4), 549-552.
Kreps, G. L. (2017). Stigma and the reluctance to address mental health issues in minority communities. Journal of Family Strengths, 17(1), 1-11. Web.
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