Significant clinical challenge in your area of practice

by | May 9, 2025 | healthcare

 

develop a PICOT question addressing a significant clinical challenge in your area of practice. The project should reflect the application of EBP principles throughout the process. You will identify a clinical problem, develop a PICOT question and conduct a literature review.

Problem Identification and Literature Review: Clearly identify a significant clinical problem within your area of expertise, justifying its selection based on evidence of a practice gap and its potential for improvement through EBP. Conduct a thorough literature review to support your choice and inform the development of your intervention. (Minimum of 5 peer-reviewed sources).
PICOT: Based on the literature review, design a PICOT question to address the chosen problem. Provide rationales for each part of your PICOT question.
Barriers and Theory Application: Identify 2-3 barriers that may exist for implementing your intervention. Using nursing theory, describe how you would overcome those barriers.

Sample solution

Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell. 

In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.


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God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.

Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.

To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.

 

References

Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.

Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.

as a healthcare professional practicing in Kenya, a significant clinical challenge I’ve observed is the suboptimal adherence to antiretroviral therapy (ART) among adolescents living with HIV (ALHIV). This is a critical issue as poor adherence leads to virological failure, increased risk of opportunistic infections, drug resistance, and ultimately impacts their long-term health outcomes and quality of life. There’s a clear practice gap as evidenced by studies showing lower adherence rates in adolescents compared to adults in Kenya (e.g., studies published in the East African Medical Journal or AIDS Care focusing on the region). Improving ART adherence in this population is a key area where evidence-based practice can make a substantial difference.

Problem Identification and Literature Review:

My choice of suboptimal ART adherence in ALHIV is supported by several factors identified in the literature:

  1. Developmental Stage: Adolescence is a period of significant physical, emotional, and social changes. Issues such as body image concerns, peer influence, rebellion against authority, and developing autonomy can interfere with consistent medication taking ( подростковый возраст).
  2. Psychosocial Factors: Stigma associated with HIV, disclosure challenges, mental health issues (depression, anxiety), lack of social support, and unstable living situations are significant barriers to adherence in ALHIV (психосоциальные факторы).
  3. Treatment Fatigue and Pill Burden: The need for lifelong daily medication can lead to treatment fatigue, especially as adolescents navigate their daily lives, school, and social activities (усталость от лечения).
  4. Knowledge Gaps and Misconceptions: Some ALHIV may have limited understanding of the importance of consistent adherence or harbor misconceptions about their medication (пробелы в знаниях).
  5. Access and System-Level Barriers: While access to ART has improved in Kenya, issues like clinic distance, transportation costs, medication stockouts at local facilities, and unfriendly healthcare worker attitudes can still pose challenges (барьеры доступа).

Literature Review (Simulated – based on likely findings in peer-reviewed journals focusing on HIV in sub-Saharan Africa and adolescent health):

  1. Kimberlin, D. W., Brady, M. T., Jackson, M. A., & Long, S. S. (Eds.). (2018). Red Book: 2018-2021 Report of the Committee on Infectious Diseases (31st ed.). American Academy of Pediatrics. 1 (While a US-based resource, it highlights general challenges of medication adherence in adolescents with chronic conditions).  
    1. www.yhoclamsang.net
    www.yhoclamsang.net
  2. Nachega, J. B., Mugavero, M. J., Giordano, T. P., Fleishman, J. A., Bartlett, J. A., & The Antiretroviral Therapy Adherence Working Group. (2010). Antiretroviral therapy adherence: what we have learned in 25 years of the HIV epidemic and what we need to know. Clinical Infectious Diseases, 50(Suppl 3), S254-S260. (Provides a broader overview of ART adherence challenges, relevant to the context of lifelong treatment).

as a healthcare professional practicing in Kenya, a significant clinical challenge I’ve observed is the suboptimal adherence to antiretroviral therapy (ART) among adolescents living with HIV (ALHIV). This is a critical issue as poor adherence leads to virological failure, increased risk of opportunistic infections, drug resistance, and ultimately impacts their long-term health outcomes and quality of life. There’s a clear practice gap as evidenced by studies showing lower adherence rates in adolescents compared to adults in Kenya (e.g., studies published in the East African Medical Journal or AIDS Care focusing on the region). Improving ART adherence in this population is a key area where evidence-based practice can make a substantial difference.

Problem Identification and Literature Review:

My choice of suboptimal ART adherence in ALHIV is supported by several factors identified in the literature:

  1. Developmental Stage: Adolescence is a period of significant physical, emotional, and social changes. Issues such as body image concerns, peer influence, rebellion against authority, and developing autonomy can interfere with consistent medication taking ( подростковый возраст).
  2. Psychosocial Factors: Stigma associated with HIV, disclosure challenges, mental health issues (depression, anxiety), lack of social support, and unstable living situations are significant barriers to adherence in ALHIV (психосоциальные факторы).
  3. Treatment Fatigue and Pill Burden: The need for lifelong daily medication can lead to treatment fatigue, especially as adolescents navigate their daily lives, school, and social activities (усталость от лечения).
  4. Knowledge Gaps and Misconceptions: Some ALHIV may have limited understanding of the importance of consistent adherence or harbor misconceptions about their medication (пробелы в знаниях).
  5. Access and System-Level Barriers: While access to ART has improved in Kenya, issues like clinic distance, transportation costs, medication stockouts at local facilities, and unfriendly healthcare worker attitudes can still pose challenges (барьеры доступа).

Literature Review (Simulated – based on likely findings in peer-reviewed journals focusing on HIV in sub-Saharan Africa and adolescent health):

  1. Kimberlin, D. W., Brady, M. T., Jackson, M. A., & Long, S. S. (Eds.). (2018). Red Book: 2018-2021 Report of the Committee on Infectious Diseases (31st ed.). American Academy of Pediatrics. 1 (While a US-based resource, it highlights general challenges of medication adherence in adolescents with chronic conditions).  
    1. www.yhoclamsang.net
    www.yhoclamsang.net
  2. Nachega, J. B., Mugavero, M. J., Giordano, T. P., Fleishman, J. A., Bartlett, J. A., & The Antiretroviral Therapy Adherence Working Group. (2010). Antiretroviral therapy adherence: what we have learned in 25 years of the HIV epidemic and what we need to know. Clinical Infectious Diseases, 50(Suppl 3), S254-S260. (Provides a broader overview of ART adherence challenges, relevant to the context of lifelong treatment).
    • study in Nairobi found that peer support groups significantly improved ART adherence among ALHIV aged 15-19 years.
    • Research in rural Kenya highlighted the negative impact of stigma and disclosure challenges on adherence rates in younger adolescents (10-14 years).
    • A qualitative study exploring the experiences of ALHIV in Mombasa revealed that feeling understood and supported by healthcare providers was a key facilitator of adherence.
  2. ** подростковый возраст, психосоциальные факторы, усталость от лечения, пробелы в знаниях, барьеры доступа (Keywords for simulated search):** Literature on adolescent development, psychosocial determinants of health behaviors, treatment fatigue in chronic illnesses, health literacy, and barriers to healthcare access in resource-limited settings.

PICOT Question:

Population: Adolescents living with HIV (ALHIV) aged 10-19 years in Kenya. Intervention: Implementation of peer support groups combined with tailored mobile phone-based reminders and adherence counseling delivered by trained youth-friendly healthcare workers. Comparison: Standard of care, which typically includes individual counseling and clinic-based follow-up. Outcome: Improved adherence to ART (defined as ≥95% self-reported adherence and virological suppression as measured by viral load <1000 copies/mL at 6 months). Timeframe: 6 months.

Rationale for PICOT Components:

  • Population (ALHIV aged 10-19 years in Kenya): This specifies the target group and the local context, acknowledging the unique challenges faced by adolescents in this setting.
  • Intervention (Peer support groups + tailored mobile phone-based reminders + youth-friendly counseling): This combines evidence-based strategies identified in the literature (peer support, reminders, tailored counseling) and considers the high mobile phone penetration among youth in Kenya as a potential delivery mechanism. Youth-friendly counseling addresses the need for age-appropriate and supportive interactions with healthcare providers.
  • Comparison (Standard of care): This provides a baseline against which to measure the effectiveness of the intervention.
  • Outcome (Improved adherence ≥95% self-reported and virological suppression <1000 copies/mL at 6 months): These are specific, measurable, achievable, relevant, and time-bound outcomes that directly reflect the goal of improving ART adherence and its clinical impact.
  • Timeframe (6 months): This is a reasonable timeframe to observe changes in adherence behaviors and virological outcomes.

Barriers and Theory Application:

Two potential barriers to implementing this intervention include:

  1. Stigma and Confidentiality Concerns: ALHIV may be hesitant to participate in peer support groups due to fear of disclosure and potential stigmatization within their communities. Ensuring confidentiality and creating a safe, non-judgmental environment within the groups will be crucial.
  2. Resource Constraints and Healthcare Worker Training: Implementing peer support groups and providing tailored mobile phone support and youth-friendly counseling requires trained facilitators, dedicated time for healthcare workers, and resources for mobile phone credits or a sustainable communication platform.

Applying Nursing Theory to Overcome Barriers: The Health Belief Model

The Health Belief Model (HBM) can be used to address these barriers by focusing on individual perceptions and beliefs about health conditions and health behaviors.

  • Overcoming Stigma and Confidentiality Concerns:

    • Perceived Susceptibility and Severity: Education within the peer support groups and counseling sessions can emphasize the continued risk of poor health outcomes if adherence is suboptimal, even with treatment. Testimonials from peers who have successfully navigated disclosure and adherence while maintaining confidentiality can increase perceived susceptibility to negative consequences of non-adherence and the perceived severity of uncontrolled HIV.
    • Perceived Benefits of Action: The intervention will highlight the benefits of participating in peer support (emotional support, shared experiences, practical tips for adherence) and using mobile phone reminders (convenience, reduced forgetfulness) in improving adherence and overall well-being.
    • Cues to Action: Healthcare workers will actively encourage participation in peer support groups and assist with setting up mobile phone reminders. Creating a welcoming and confidential atmosphere in the groups and during counseling will act as positive cues.
    • Self-Efficacy: Providing skills-building sessions within the peer support groups on how to manage disclosure, cope with stigma, and integrate medication taking into daily routines will enhance participants’ self-efficacy in adhering to ART. Youth-friendly counseling will also empower adolescents to take ownership of their health.

  • Addressing Resource Constraints and Healthcare Worker Training:

    • Perceived Benefits of Action: Emphasize to healthcare administrators the long-term benefits of improved adherence (reduced hospitalizations, fewer opportunistic infections, decreased drug resistance), which can lead to cost savings in the long run. Present evidence from the literature on the effectiveness of peer support and mobile health interventions.
    • Cues to Action: Advocate for dedicated funding and training programs for healthcare workers on facilitating peer support groups and delivering youth-friendly counseling. Explore task-shifting strategies where trained lay counselors or peer leaders can assist with group facilitation and basic adherence support, freeing up healthcare workers for more complex clinical tasks.
    • Self-Efficacy: Provide comprehensive training to healthcare workers on adolescent development, communication skills, and the specific needs of ALHIV. Offer ongoing mentorship and support to build their confidence and competence in delivering the intervention effectively.

By applying the Health Belief Model, the intervention aims to influence the perceptions of ALHIV regarding the benefits of adherence and participation in the support system, while also addressing the perceived barriers of stigma and resource limitations through education, empowerment, and strategic resource allocation.

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