Literature-based dissertation project:

CRITICAL OR SYSTEMATIC REVIEW

student name:

ANONYMISED

student number:

ANONYMISED

HERE provide a very brief (maximum 100 words) overview of the study: Aims? What is involved? Methods and intended outputs?

Aims: To review strategies of mental health nurses in promoting recovery-focused care in an acute inpatient ward critically. To ascertain the factors that affect compliance, such as barriers and facilitators. Methods: A critical literature review and a systematic search utilizing multiplex databases will be essential in acquiring a complete comprehensive search outcome. Also, there will be a synthesis of the findings through assessing the associations within and linking the effect and utilizing the relevant theoretical framework for the review’s structure. Intended outputs: The critical review will be essential for the guidance of mental health nurses on the intervention approaches that may be implemented while promoting recovery-focused care in an acute inpatient ward.

PROPOSAL FOR A LITERATURE-BASED DISSERTATION

Principle Question:

A critical review to identify the optimal strategies that mental health nurses can use to promote recovery-focused care in the acute inpatient wards.

Background and justification for the study:

Improvement regarding treatment and care of individuals having a mental disorder is among the major priorities for health care settings and healthcare professionals. Health professionals introduced recovery’s concept in the service user movements during the 1970s, which led to its attention among the policymakers and the researchers focusing on mental health. In 1993, Anthony highlighted that the future directing mental health care’s vision is to plan all the mental health services in the category of recovery vision’s umbrella (Spandler & Stickley, 2011). Since then, recovery’s concept gradually pervaded political agendas, becoming the organization’s central part and mental health services delivery. As a result, recovery-focused care has become the major part of mental health policies of most countries worldwide, such as the US, Denmark, UK, and Australia. According to Wells and McCaig, recovery-focused care in acute inpatient wards refers to a paradigm transformation from a single-dimensional medical strategy towards treating individuals having a mental illness (2016). Repper and Carter (2011) highlight that recovery-focused care focuses on principles and values of individual orientation and individual involvement instead of merely emphasizing rapid stabilization and symptom relief due to the clinical practices. Regarding this philosophy, recovery-focused care’s general target is to offer support by obtaining a substantial and satisfying life by promoting hope, social inclusion, individual targets’ attainment, and supportive associations.

Recovery-focused practice’s idea has resulted in research’s upsurge and transformations towards the mental health care’s components. Therefore, it currently plays a crucial role in guiding most organizational advancements in the services regarding mental health. Conversely, although researchers, policymakers, and individuals with mental disorders have made multiple efforts to define and create guiding principles about recovery-focused practices, its implementation has been challenging. Moreover, most values and regulations associated with recovery-focused care practices have been made in the community’s outpatient and mental health settings. As a result, this review focuses on the mental health nurses’ strategies to promote recovery-focused care in acute inpatient wards.

What is the value of this review?

Recovery refers to a decrease in the mental health signs and symptoms, which locates the person in limited remission regarding their psychiatric disorder. On the contrary, recovery-focused care, specifically in mental health, involves the capabilities surrounding the orientation of the thinking and feelings of every individual involved in achieving the optimal outcome (Pithara et al., 2020). Efforts in recoveries in focused care are vital in the case management’s last phase achieving the complete restoration of the patient’s health status. The conceptualization regarding recovery of patients is associated with their connection with health care professionals as an influence of their recovery and care positively. The mental health nurses assist in motivating recovery focused care through utilizing operative approaches, exhibiting optimistic feelings, and having the important capabilities for the patient’s recovery journey (Cambridge Core, 2018). As findings reveal, mental health recovery is highlighted as the major target of patients suffering from mental health disorders. Therefore, recovery as a personalized journey is important in promoting healing and helping people restore their functioning level. However, despite the important need regarding focused care delivery’s a phase, most organizations, health facilities, and centers for rehabilitations promote their capabilities in achieving standardized care inadequately through executing an appropriate recovery framework for the mental health patients.

Significantly, strategies of promoting recovery-focused care in acute inpatient wards are needed in the healthcare systems. The critical review will be necessary to guide the mental health nurses on the strategies to promote recovery-focused care in the acute inpatient ward.

Research Question:

The framing of the research question is through the use of the PICO abbreviation (Participants, Interventions, Comparisons, and Outcomes). Higgins and Green (2011) explores the use of PICO in the Cochrane Handbook regarding interventions’ reviews systematically.

‘What are the optimal strategies (Intervention/Comparison) for promoting recovery focused care (Outcome) in acute inpatient ward? (Population)’

Aim and Objectives:

1. To review critically the strategies of mental health nurses in promoting recovery-focused care in the acute inpatient ward.

2. To ascertain the factors that affect compliance, such as barriers and facilitators.

Method:

This research will take place through critical review and the use of systematic analysis. Greyson et al. (2019) explored that this includes a study focusing on searching strategies and synthesizing the methods based on the subject matter and proof being examined. As analyzed by Greyson et al., it involves a search review characterized through three core components: comprehensive, open, and systematic (2019). Also, Grant and Booth states that systematic search involves a thorough and extensive investigation of multiplex literature to allow the synthesis of and appraisal of pieces of evidence (2009). Systematic search is a significant element regarding systematic review method (Cooper et al., 2018). The process, therefore, comprises of systematic search among studies, and it targets openness findings of the research’s identification which plays a crucial role in leaving the audiences clear regarding the processes in the identification of the studies and how the review’s findings imply in the evidence relevance. Also, the review will involve observational studies due to the sensitivity of the topic under investigation. Based on the various types of research implied in the study, the research will minimize biases that issues of conflict of interest might cause.

The critical review evaluates research systematically and carefully to explore its relevancy, value, and trustworthiness in a specific context. Literature searches utilizing databases such as EMBASE or Medline are associated with an overwhelming results’ volume, which can vary in quality. Besides, the researchers searching on medical literature for CPD’s purposes or in reaction towards a clinical query will identify that vast content’s amount exists (Morrison, 2017). A critical review thus assists in decreasing the burden associated with extensive ranges and allows the researcher to emphasize sources that are appropriate for the research question under study.

Similarly, the review process will be done depending on the PRISMA statement’s recommendation. As discussed by Moher et al., PRISMA plays a role in assisting authors in advancing the systematic reviews’ reporting especially interventions’ assessment (2009). Adhering to the PRISMA recommendations will improve the integrity of this work.

Search Strategy:

Critically reviewing is relevant based on the data being critically evaluated. In carrying out critical reviews, primary studies as part of the researcher’s studies for documentation of the literature review is necessary.

For this review, the researcher will utilize primary sources obtained from various databases. These include:

• Google and Google Scholar- Provides the academic community with the relevant content, which plays a role in satisfying the relevancy of the scholars’ needs by allowing the users to search various materials, including books and articles on numerous topics.

• Cochrane Library- Includes a database’s collection containing various types of high-quality data which has independent proof in the informing of the decisions makings regarding healthcare. Internationally, the reviews about Cochrane Library identify it as one of the highest quality in health care based evidence.

• Science Direct- Is the globe’s leading source for research in various fields such as medical, scientific, and even technical.

This review involves the breaking down of the research question into synonymous search phrases. These include:

‘What are the optimal interventions/tools for promoting recovery-focused care in acute inpatient ward?’

Psychoeducational OR Education OR intervention OR psycho-social OR support

AND

Promote Recovery OR adherence OR increase the use

AND

Focused care OR dilator

AND

Acute Inpatient Ward

The combination of the phrases will occur through the Boolean logic. The Boolean logic allows the users to understand the order of the processes and the keywords resulting in a significant return as an outcome. The researchers obtain vast data at their fingertips through the Boolean logic, finding the appropriate data. Nevertheless, all the searches used in the research will be recorded to enable transparency and reproducibility of the research process. There will be reviewing all the topics, titles, and abstracts in this review, depending on their eligibility. The studies that will fail to satisfy the particular criteria will be excluded based on the eligibility criteria. However, the recording will identify the reason for exclusion.

This review will use the PRISMA flow diagram to illustrate how information flows from various search stages for transparency purposes.

Thus, as Moher et al. (2009) explored, Appendix 1 highlights the included, excluded, and identified records in the research. It also identifies the reasons for exclusions.

Inclusion / Exclusion Criteria:

The exclusion and inclusion criteria refer to the boundaries deciding appropriately the data the researcher wants to identify in the literature search. This allows the user to decide the sources to either be excluded or included in the results. The exclusion and inclusion criteria are essential in obtaining comprehensive search literature.The research will involve the searching of grey literature and those formally not published, such as the use of reports, governmental searches, conference processes, abstracts, dissertations, among others. The researcher will consider various aspects based on selecting the sources to be excluded or included. These include the communities the study will focus on, the healthcare general practice, the publication dates involving the reasons why there was a restriction in the search dates, the study design, and lastly, the scope of the studies.

Inclusion:

Studies will be included if they focus on the research question recovery-focused care, if the publication date did not exceed 20 years ago, if the studies have both quantitative searches and if investigations have interventions on the topic under investigation. Additionally, studies included in the study designs are observational, experimental, or randomized controlled trials (RCTs). The inclusion of various study designs is essential in ensuring the review outcome is comprehensive. Proper inclusion is also significant in optimizing the internal and external study’s validity by increasing the probability of attaining reproductive and reliable results.

The study’s population includes individuals with mental health illnesses who have received recovery-focused care while in the acute inpatient ward. The effectiveness of this review is through ascertaining the factors that affect compliance, such as barriers and facilitators. Thus, the included interventions will comprise counseling services, psychoeducational programs, and behavioral methods, among others. The inclusion of all these aspects will assist in completing the review.

There will also be an assessment of the primary outcomes. These include:

• Compliance with recovery-focused care.

• How long is the maintenance of the compliance.

There is also the assessment of the secondary outcomes. These include:

• The barriers and facilitators affecting compliance.

Exclusion:

The studies that will undergo exclusion are those of case reports. According to Pannucci and Wilkins, case reports are less reliable because they are low evidence-based (2010). Most of them contain biasness of the author’s opinions and conflict of interest, and controlling such confounding factors is usually difficult (Pannucci & Wilkins, 2010). The subject populations that must not be used is that which lack the attributes of accomplishing the research’s purpose. For instance, the population of those not experiencing mental health disorders will be excluded. Other articles that will be excluded are those identified as having a conflict of interest, those papers majoring on opinions, and literature restricting the assessment of the evidence’s quality. Also, literature written in Non- English language will be excluded due to a lack of translation sources.

Method of Critical Appraisal/analysis:

As revealed in various findings, critical analysis is significant in combating information overload, and identifying relevant papers for Continuing Professional Development (CPD). The researcher will determine if the articles are suitable and appropriate for the study and correspond to the research question. This will be done by evaluating the study’s aim if the conclusion measures the interest’s question, if the results are significant, and through the methods and materials used.

The researcher will also respect and consider culture during critical analysis. As identified in the topic, the review focuses on UK practice. Therefore the review should focus on specifically the UK as those of other countries or cultures may be contrasting.

The review process will involve various techniques. These include addressing potential biases, consistency in interpreting the results, understanding null findings, generalizations, clinical implications, ethical approval, ethical issues, and whether the results apply to the study’s population.

To ensure the review is of quality, there will be the adoption of an appraisal tool. The tools play a significant role in appraising the reliability, essence, and clinical evidence’s applicability. The critical appraisal should address whether the study focuses on a clear question, has valid results, and uses accurate processes to address the research question (Centre for Evidence-Based Medicine, 2021). Thus the critical analysis will be essential in assessing the various aspects of the study and assessing the risks that may be associated with it.

Data Extraction and Synthesis:

In a systematic review, data synthesis results from individual research studies and are suitable for the research question. Systematic reviews explore the role of analyzing the literature, which leads to assisting the health care professionals in sustaining the current evidence in the medical field. Data extraction and synthesis together with a combination of data from multiple studies is a single crucial way through which systematic review surpasses subjective narrative describing components of a traditional literature review. Therefore, data synthesis is critical in making up the results review section in obtaining the results.

The review will also include an initial descriptive synthesis. Descriptive synthesis explores the findings’ synthesis from multiple studies, which depend on utilizing both texts and phrases to explain the synthesis’s conclusions. Centre for Reviews and Dissemination highlights that synthesis will draw reliable decisions based on the evidence provided (2009). In this review, the essential details that will be summarized include the interventions employed and the study size measure of the results.

Theoretical Framework:

Theoretical frameworks explain the approaches towards recovery-focused care by offering advice to the individuals responsible for implementing such programs in fulfilling the proficiencies among the beneficiaries. For this review’s structure and informing of this review’s synthesis, a relevant theoretical framework is necessary. Another essential framework to be used in this review is the behavioral theories. The interventions on this theory discuss human behavior through assessing the impacts and antecedents available in the person’s environment and the associations he has obtained from the activities of the previous experience. According to Chang et al., interventions on behavioral theories are important in increasing the treatments’ efficacy and effectiveness (2014). Thus, the Information-Motivation and Behavioural Model (IBM), which Fisher and Fisher (2014) proposed, will be applied in informing this review’s synthesis. The model discusses that information-motivation and Behavioural capabilities are important in engaging a provided health behavior in patients and developing behavioral interventions among patients.

The mental health nurses implementing recovery focus care need to introduce, develop, and evaluate evidence-based practice (EBP). The lowa model Katowa-Mukwato et al. (2021) gives a framework for holistically describing the strategy. The model is of high standards towards biomedical practice’s theory, which is inadequate in most healthcare settings, particularly evidence-based care delivery. The lowa model comprises seven important methods that need to be observed during the implementation of EBP and involves the organization’s members, the patients, stakeholders, and healthcare structures. According to Katowa-Mukwato et al., knowledge-focused triggers involve EBP components, processes, philosophies, and organizational policies (2021). The lowa model directs patient recovery’s implementation, hence streamlining quality’s advancement in assisting patients with a mental illness to experience fast recovery.

Another important theoretical framework to be used in the synthesis of this review is the sociological theory. The theory involves the concepts of Conflict perspective, Interactionism, and Functionalism. The essential idea that will apply in this review is Interactionism which focuses on constructions between individuals during their interaction (Housley & Smith, 2017). Therefore, interactions between the mental health nurses and the inward patients will effectively advance compliance.

Maximizing reliability and validity:

This review will ensure that there is topmost elimination of biasness. Eliminating data will occur through various steps. These include:

• Creating a clear and detailed protocol and adhering to it.

• Sustaining transparency in all the recording and documenting operations throughout the reviewing process.

• Studying inclusion, synthesis, and extraction of data through a structured approach.

• Appraising the articles’ samples through the use of a second blind reviewer.

Dissemination of the review:

The researcher may disseminate this review’s findings to health practitioners, particularly mental health nurses, by reporting the concluded results in academic journals such as the oncology-associated journals. The findings can also be disseminated as a poster during conferences or shared through emails. There can also be dissemination through brochures and leaflets, which will inform the patients.

The targeted audiences that will find this review useful include the patients undergoing recovery-focused care in acute inpatient wards and the healthcare professionals providing care to this sample population, such as the mental health care nurses. This review’s findings would be important in impacting the clinical practice. If this review’s conclusions demonstrate effectiveness in recovery-focused care, it can decrease the NHS’s cost. This is because focused recovery care in most health facilities in the UK has shown increased cost in materials. Furthermore, by identifying the strategies and improving their compliance, there will be a better connection linking the patients and the health care professionals, which helps advance the patients’ experience.

Ethical Considerations:

Currently, there is a lack of reviews assessing the optimal interventions improving focused care delivery in the acute inpatient ward. This review lacks ethical considerations because it involves a critical appraisal that does not require data collection through human participants and primary data. However, if the assessment identifies ethical misconduct regarding the preliminary studies, excluding the articles will occur.

Timeline:

	Sept 2020	Oct 2020	Nov 2020	Dec 2020	Jan 2021	Feb 2021	March 2021	April 2021	May 2021
Proposal Submission
Perform Searches
Data synthesis & development themes
Write up a critical review
Submit review

Appendix 1

PRISMA 2009 Flow Diagram

References

Cambridge Core. (2018). Recovery-oriented mental healthcare: The British Journal of Psychiatry. Cambridge University Press. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/recoveryoriented-mental-healthcare/F47248E49FA07DA4B6F923DF9A93C554

Centre for Evidence-Based Medicine. (2021). Critical Appraisal tools. The University of Oxford. https://www.cebm.ox.ac.uk/resources/ebm-tools/critical-appraisal-tools. Accessed on June 14^th, 2021

Centre for Reviews and Dissemination. (2009). Systematic reviews: CRD’s guidance for undertaking studies in health care (3rd ed.). York: CRD University of York. Retrieved from https://www.york.ac.uk/media/crd/Systematic_Reviews.pdf

Chang, S. J., Choi, S., Kim, S., & Song, M. (2014). Intervention strategies based on information-motivation-behavioral skills model for health behavior change: A systematic review. Asian Nursing Research, 8(3), 172-181. doi://doi.org/10.1016/j.anr.2014.08.002

Cooper, C., Booth, A., Varley-Campbell, J., Britten, N., & Garside, R. (2018). Defining the process to literature searching in systematic reviews: a literature review of guidance and supporting studies. BMC medical research methodology, 18(1), 1-14. https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-018-0545-3

Fisher, J. D., & Fisher, W. A. (1992). Changing AIDS-risk behavior. Psychological Bulletin, 111(3), 455-474.

Grant, M. J., & Booth, A. (2009). A typology of reviews: An analysis of 14 review types and associated methodologies. Oxford, UK: doi:10.1111/j.1471-1842.2009.00848.x

Greyson, D., Rafferty, E., Slater, L., MacDonald, N., Bettinger, J. A., Dubé, È., & MacDonald, S. E. (2019). Systematic review searches must be systematic, comprehensive, and transparent: a critique of Perman et al. BMC Public Health, 19(1), 1-6. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6275-y

Higgins J.P.T. and Green S. (2011). Cochrane handbook for systematic reviews of interventions version 5.1.0. Retrieved from http://handbook-5-1.cochrane.org

Housley, W., & Smith, R. J. (2017). Interactionism and digital society. Qualitative Research, 17(2), 187-201 https://orca.cardiff.ac.uk/98960/1/Interactionism%20and%20Digital%20Society_ORCA.pdf

Katowa-Mukwato, P., Mwiinga-Kalusopa, V., Chitundu, K., Kanyanta, M., Chanda, D., Mwelwa, M. M., & Carrier, J. (2021). Implementing Evidence-Based Practice nursing using the PDSA model: Process, lessons, and implications. International Journal of Africa Nursing Sciences, 14, 100261. https://orca.cardiff.ac.uk/136079/3/1-s2.0-S2214139120301384-main.pdf

Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLOS Medicine, 6(7), e1000097. Retrieved from https://doi.org/10.1371/journal.pmed.1000097

Morrison, K. (2017). Dissecting the literature: the importance of critical appraisal. Royal college of surgeons. https://www.rcseng.ac.uk/library-and-publications/library/blog/dissecting-the-literature-the-importance-of-critical-appraisal/

Pannucci, C. J., & Wilkins, E. G. (2010). Identifying and avoiding bias in research. Plastic and Reconstructive Surgery, 126(2), 619-625. doi:10.1097/PRS.0b013e3181de24bc

Pithara, C., Farr, M., Sullivan, S. A., Edwards, H. B., Hall, W., Gadd, C., & Horwood, J. (2020). Implementing a digital tool to support shared care planning in community-based mental health services: a qualitative evaluation. Journal of medical Internet research, 22(3), e14868. https://www.jmir.org/2020/3/e14868/PDF

Repper, J., & Carter, T. (2011). A review of the literature on peer support in mental health services. Journal of mental health, 20(4), 392-411. https://health.wyo.gov/wp-content/uploads/2018/01/Repper-and-Carter-PSS-lit-review.pdf

Spandler, H., & Stickley, T. (2011). No hope without compassion: the importance of compassion in recovery-focused mental health services. Journal of Mental Health, 20(6), 555-566. https://www.researchgate.net/profile/Helen-Spandler/publication/51839458_No_hope_without_compassion_The_importance_of_compassion_in_recovery-focused_mental_health_services/links/0922b4f8f03560340c000000/No-hope-without-compassion-The-importance-of-compassion-in-recovery-focused-mental-health-services.pdf

Wells, K., & McCaig, M. (2016). The magic wand question and recovery‐focused practice in child and adolescent mental health services. Journal of Child and Adolescent Psychiatric Nursing, 29(4), 164-170. https://www.researchgate.net/profile/Marie-Mccaig/publication/309468890_The_Magic_Wand_Question_and_Recovery-Focused_Practice_in_Child_and_Adolescent_Mental_Health_Services_The_Magic_Wand_Queiktion_and_Recovery-Focused_Practice_in_Child_and_Adolescent_Mental_Health_Servic/links/5af418850f7e9b026bcd05ca/The-Magic-Wand-Question-and-Recovery-Focused-Practice-in-Child-and-Adolescent-Mental-Health-Services-The-Magic-Wand-Queiktion-and-Recovery-Focused-Practice-in-Child-and-Adolescent-Mental-Health-Servic.pdf