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Quantitative Apprasial Paper

Kayla Barnes

University of South Alabama

NU 608: EBP & Quality Improvement HCS

Dr. Lollar

October 17, 2022

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Quantitative Apprasial Paper

Schizophrenia is a severe complex disorder in which the symptoms can present many

daily challenges for the patients and health care providers. According to Pinho et al. (2020), there

is a form of cognitive behavioral therapy (CBT) that improves delusions and psychosis in those

with schizophrenia, and it is called metacognitive training. Health care providers may need to

individualize metacognitive training based on patient preferences and symptoms

(Moritz et al., 2022)
. Advanced practice nurses can aid in improving patient outcomes in those with

schizophrenia by incorporating cognitive behavioral therapy, such as metacognitive training

along with pharmacological interventions. This paper will discuss the impact metacognitive

training has on psychotic symptoms, daily function, and cognitive thinking.

Quantitative Research

There are many different methods used when researching specific information, but when

one is wanting to gather numerical data the method of choice would be quantitative. Quantitative

research can be described as collecting, analyzing data, and testing hypotheses. The research data

obtained will be numerical and used to clearly understand trends or patterns pertaining to the
(Polit & Beck, 2020)
population .

Advanced practice nurses use the data obtained from quantitative research to evaluate the

best interventions for patient outcomes. Being that the data is numerical and statistical

adjustments to care can be made precisely. The data obtained through randomized controlled

trials, or a meta- analysis can be used by the advanced practice nurse to determine the impact

metacognitive training has on psychotic symptoms and daily function.

The methods in which data collection could be obtained for this topic could include

surveys, interviews, or structured observation. The survey can be a series of questionaries

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pertaining to positive symptoms often displayed by those with schizophrenia. The interview can

be a way to determine which individuals meet criteria needed to be study participants

Observation would include comparing before and after behaviors and daily function of patients

with schizophrenia to evaluate if the outcome is the expected results. Data collection is a very

integral part of the research process, therefore, the means in which the data is obtained should be
(Polit & Beck, 2020)
accurate so decisions regarding patient care are made effectively .

Quantitative Single Study Article

Quantitative research methods help to give valid statistical data to help guide clinical

practice and make changes as needed. This study conducted by Pinho et al. (2020) was intended

to evaluate the effectiveness of metacognitive training on patients with a schizophrenia diagnosis

in a group setting. The purpose of the study was to decide if metacognitive training improved

psychosis, cognitive awareness, and daily function. Pinho et al. (2020), study design was a

randomized controlled trial (RCT) which followed the Consolidated Standards of Reporting

Trials (CONSORT) guidelines. This study included four phases enrollment, intervention

allocation, follow-up, and data-analysis. The participants were assigned at random into two

groups, the experimental or control group. In the control group metacognitive training was not

received, but both groups received treatment as usual (TAU). Criteria for which participants

were assigned to the groups involved level of education, length since onset of schizophrenia, and
(Pinho et al., 2020)
treatment received .

The study sample consisted of 56 patients between the ages of 18-65 with a schizophrenia

diagnosis, no medication changes within the last four months, and no severe psychotic symptoms

to obstruct understanding of objectives of the study. Each participant received an individual

explanation of the study so written consent could be obtained. The group sessions were face-to
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face in a quiet room two times per week for three months. The sessions were 45-60 minutes and
(Pinho et al., 2020)
followed the Metacognitive Training for Psychosis manual . Metacognitive

training helps to improve positive symptoms of psychosis by improving cognitive biases and

developing new problem-solving techniques.

There were modules that exemplified a way of thinking that was identified as factors

causing the development of delusions. There were examples and illustrations of psychotic

experiences that happen in real life that impair thinking and nonadaptive coping strategies. The

participants learned substitution methods for the nonadaptive coping strategies and were given
(Pinho et al., 2020)
brochures at the end of each session for exercises to practice at home . The

outcomes of this study were measured by Beck Cognitive Insight Scale (BCIS), Personal and

Social Performance Scale (PSP), and Psychotic Symptom Rating Scale (PSYRATS). They were

distributed to both groups before the first session, after the eight sessions, and three months later
(Pinho et al., 2020)
during follow-up evaluation .

Validity and reliability are important concepts when it comes to the data collection

methods used during research. Validity is the data being accurately measured whereas reliability
(Hall & Roussel, 2020, pp. 8–9)
is the results being the same if used on different occasions .

Pinho et al. (2020) study was registered in the Clinical Trial Registry Platform and the

metacognitive training intervention has been used in other countries with studies published. The

psychiatric nurses were trained before to use the intervention, and the same investigator

distributed the questionnaires during the three-time frames. The investigator had clinical and

research experience with the treatment of schizophrenia (Pinho et al., 2020). The data collection

included that the researcher was not aware of which groups the participants belonged to. The
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data collection was also obtained in face-to face interviews at three different organizations with

the metacognitive training directed by three different psychiatric nurses.

At the end an anonymous questionnaire was given to evaluate the appropriateness and

subject effectiveness of interventions. The results of the study showed metacognitive training

had similar effects as antipsychotics on patients with schizophrenia. It decreased delusions and

improved social skills and self-awareness. The study also proved that mental health nurses can

successfully deliver metacognitive training (Pinho et al., 2020). According to Pino et al. (2020),

metacognitive training groups should be implemented into rehabilitation programs for patients

with schizophrenia soon after diagnosis and family psychoeducation to complement

metacognitive training.

The strength of the study is rated Level I and the quality is rated B determined by the

study being a randomized controlled trial and having reasonably consistent results and

recommendations. There were studies conducted on different ages of patients with

schizophrenia, some previous trials did not show significant improvement in cognitive insight as

did this trial Therefore, there was uncertainty about whether cognitive awareness is hard to

change and may require continuous everyday training and longer follow-up (Pinho et al., 2020).

The recommendation from this study included the implementation of metacognitive groups into

rehabilitation programs for patients with schizophrenia. This is a way for individuals to begin

training his or her mind early to slow the development of delusions. Metacognitive training along

with antipsychotic medications incorporated in everyday practice can improve daily function in

those with schizophrenia.

Quantitative Meta-Analysis Article

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This study conducted by Mizuno et al. (2019) was set out to answer the question of

whether clozapine was more effective in patients with treatment resistant schizophrenia in

relation to other antipsychotics. This study carried out a meta-analysis of published data from

double-blind randomized controlled trials to test for symptom change with treatment resistant

schizophrenia (TRS) patients receiving clozapine in comparison to other antipsychotics (Mizuno

et al., 2019). This study adhered to the reporting preferred systematic review and meta-analyses

(PRISMA) statement, and study selection came from browsing different databases including

Medline, Cochrane CENTRAL, and PsychINFO. There were 39 studies that met study criteria

after careful data extraction. The research findings were synthesized and compared through

meta-analysis of variance of total symptom change measured by the Brief Psychiatric Rating

Scale (BPRS), meta-analysis of mean difference of total symptom change measured by Positive

and Negative Syndrome Scale (PNSS), and meta- regression measured by both scales (Mizuno et

al., 2019).

The findings concluded that there were no significant changes in the effectiveness of

clozapine in comparison to other antipsychotics for patients with treatment resistant

schizophrenia. The findings did suggest that there was greater improvement in positive

symptoms in relation to clozapine taken for treatment resistance schizophrenia (Mizuno et al.,

2019). The clinical implications included that clozapine was superior in both treatment resistant

and non-resistant schizophrenia. Higher doses of clozapine showed greater benefit with total,

negative, and positive symptoms, however no optimal dose was determined. Observational

studies conducted showed a reduced mortality rate in patients with schizophrenia taking

clozapine, but clozapine being underused in clinical settings (Mizuno et al., 2019),
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The quality of evidence for this study is rated B and Level I for strength. This study was

a meta-analysis of 39 double-blind randomized controlled trials that had limitations in sufficient

sample size for study design and fairly definitive conclusions. There were only 10 studies

included of strictly defined treatment resistant schizophrenia therefore, this implicated a need for

a better study design in future studies (Mizuno et al., 2019). The variance was also limited in

number of studies that reported standard deviation for symptom change. This weakened the

context of the data interpreted. This study concluded that clozapine improved total and positive

symptoms not only in treatment resistant patients, but also in patients without recognized

treatment resistance. However, there is a need for more research regarding patients taking

clozapine without recognized treatment resistance in the early stages of schizophrenia. Overall,

the conclusions of this study did not find a systematic difference in variability of symptom

change in patients with treatment resistance schizophrenia taking clozapine and other

antipsychotics (Mizuno et al., 2019).

Applicability to Practice and Future Research

The Institute of Medicine has six aims for improvement that provide the framework to
(Shenoy, 2021)
provide quality care for health care systems . The recommendation in the study

conducted by Pinho et al. (2020) to incorporate metacognitive training groups into rehabilitation

programs for patients with schizophrenia is equitable. This recommendation is for all patients

with a schizophrenia diagnosis no matter gender, ethnicity, or socioeconomic status to receive

metacognitive training as soon as possible. The study conducted by Mizuno et al. (2019) has

effectiveness in providing accurate data pertaining to the efficacy of clozapine in treatment and

non-treatment resistant schizophrenia. This study provides numerical data of clozapine in

comparison to other antipsychotics which can lead health care providers to precisely make
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decisions about medication regimen for individuals with schizophrenia. Both studies are patient -

centered with the goal of providing the best care for patients with schizophrenia whether

pharmacological or nonpharmacological interventions. Advanced practice nurses can implement

the findings from both studies into practice for the treatment of patients with schizophrenia.

Conclusion

No matter what data collection method is used during a quantitative study the most

important aspect is that the data is accurate and measures what is it supposed to. Advanced

practice nurses need to be able to utilize research findings to evaluate the best interventions for

patients.
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References

Hall, H. R., & Roussel, L. A. (2020). Evidence-based practice: An integrative approach to

research, administration, and practice: An integrative approach to research,

administration, and practice (3rd ed.). Jones & Bartlett Learning.

Mizuno, Y., McCutcheon, R. A., Brugger, S. P., & Howes, O. D. (2019). Heterogeneity and

efficacy of antipsychotic treatment for schizophrenia with or without treatment

resistance: A meta-analysis. Neuropsychopharmacology, 45(4), 622–631. HYPERLINK

"https://doi.org/10.1038/s41386-019-0577-3"https://doi.org/10.1038/s41386-019-0577-3

Moritz, S., Menon, M., Balzan, R., & Woodward, T. S. (2022). Metacognitive training for psychosis (mct): Past,

Pinho, L., Sequeira, C., Sampaio, F., Rocha, N., Ozaslan, Z., & FerreGrau, C. (2020). Assessing the efficacy and

Polit, D., & Beck, C. (2020). Essentials of nursing research: Appraising evidence for nursing practice (10th ed.).

Shenoy, A. (2021). Patient safety from the perspective of quality management frameworks: A

review. Patient Safety in Surgery, 15(1). HYPERLINK "https://doi.org/10.1186/s13037-

021-00286-6"https://doi.org/10.1186/s13037-021-00286-6