Literature Review Paper – Due: November 20, 2023Retrieve evidence that is relevant to the topic via a literature review of pertinent clinical researchstudies, systematic reviews, meta-analyses, and non-research practice and/or theory literature• It is important to find the strongest evidence available in the quest for knowledge aboutthe selected topic – the evidence review must include a discussion on strength of theevidence found (use the evidence pyramid in LoBiondo-Wood & Haber 10 th ed. p. 15)• The Literature Review Paper is a 5-6 page paper that includes 5-6 pages ofnarrative plus a title page & reference page(s). You are to follow APA 7 th editioncitation style (professional format) and use level headings within the paper. Submitthis paper in MOODLE.• Include the topic and PICO question (revised since Part I if necessary) at the beginning ofthis paper.• Include the following in your paper:o As discussed in the NCSU video on literature reviews,https://www.lib.ncsu.edu/tutorials/litreview/, you are to present a synthesis of theliterature (6 references). Please select six references from your reference list(Part II). Remember that your goal is to review the strongest evidencepossible on your selected topic so choose your references wisely. Only six ofyour references will be used in an effort to keep the paper at 5-6 pages maximum.o This paper is not to be written in first person. Therefore, the paper should notinclude personal pronouns, i.e., I, she, heo Writing a synthesis does not mean you are presenting an annotated bibliographyor summary of each reference in your paper. Instead, you must identify themes orconcepts presented in your selected literature and discuss these with respect to anyconsistencies and inconsistencies between references. Each reference needs to bediscussed and related to other selected references. Include your own thoughts andideas concerning the themes in your evidence.o All references are to be primary references, not secondary references (see:https://umb.libguides.com/PrimarySources/secondary). For instance, if you areciting Patricia Benner’s theory of Novice to Expert you need to cite the firstpublication by Benner explaining her theory as this is a primary source/reference.You would NOT use your NUR 5005 textbooks to cite Benner’s theory unlessBenner had authored a chapter about her theory in the text.o All references are to be published within the last five years (2017-2022) with afew exceptions. If the reference is considered a “gold standard” for being the firstto identify a phenomenon, theory, etc., then it is fine to include it as a reference(even if it was published before 2017).
You should include a section, with the appropriate level heading per APA, todiscuss the levels of evidence your references cover.o You should include a section on consistencies & inconsistencies found withinyour selected body of evidence.Grading of Literature Review Paper:• Introduction that includes the topic and PICO question(revised since Part I if necessary) 10 pts ______• Six (6) references selected from your evidence table that are reviewed& presented as a synthesis. 30 pts ______-Identifies themes or concepts within the body of evidence-Does not present each article individually as a summary or annotatedbibliography• Identifies & discusses the consistencies and inconsistencies found within the evidencewith respect to each theme/concept 15 pts ______• Identifies and discusses the levels of evidence of your references 15 pts ______• Conclusion that includes a connection made to nursing practice 10 pts ______• Writing mechanics: Grammar, punctuation & spelling 10 pts ______-Does not write in first person point of view• APA format 10 pts ______-Uses APA 7 th edition professional format
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Literature Review: Naloxone Distribution Education Programs
Shana Spratt
College of Nursing, Elms College
November 13, 2023
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Literature Review: Naloxone Distribution Education Programs
Overview
Opioid overdose takes place when an individual consumes a quantity of these drugs that
exceeds the ability of the body to metabolize and process them. Such an occurrence can result in
various symptoms, such as respiratory problems, loss of consciousness, or even death (Haegerich
et al., 2019). Haegerich et al. (2019) suggest that identifying strategies that can aid in preventing
opioid overdose and influence patients and provider actions is vital. This research emphasizes
that establishing approaches necessary for treatment processes is critical in preventing opioid
abuse and overdose. Opioid overdose in tertiary settings calls for effective approaches and
specialized care. The naloxone distribution overdose education program is one effort to address
and respond to opioid overdose. According to Razaghizad et al. (2021), the increase in overdose
education and naloxone distribution programs has been proposed as a potential response to the
opioid crisis. Razaghizad and associates researched to explore the effects and viability of these
programs and identify areas for optimization. This study established that the programs lead to
long-term knowledge enhancement concerning opioid overdose. The research further found that
overdose education and naloxone distribution programs improved patients’ attitudes concerning
naloxone and reduced opioid-associated mortality.
These findings resonate with insights by Jakubowski et al. (2019). This study suggests
that overdose education and naloxone distribution to inpatient medical environments can
potentially reach people at high risk, especially those who do not have access to decreased
services and have obtained training. Findings by Jakubowski and associates indicated that
incorporating such a distribution is attainable and has the capacity to reach the target patients.
Similarly, Rudisill et al. (2021) agree that these programs reduce opioid-associated fatalities.
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According to Lambdin et al. (2020), education interventions can prevent certain infections such
as the human immunodeficiency virus. Similarly, the research provides that such knowledge
obtained through such initiatives can lead to a reduction in opioid overdose deaths. These
programs train caregivers in tertiary settings on how to respond during overdose events and offer
guidelines on drug delivery.
Facilitators of Implementation
Several facilitators have been associated with the effective implementation of these programs.
For example, Rudisill et al. (2021) carried out structured interviews among internal and external
stakeholders in a healthcare facility. The research found that the primary facilitators include
combined efforts, ease of contributing to the programs, need for naloxone and individual
protection from an overdose. Likewise, Sellen et al. (2023) identified factors that facilitated the
effective implementation of naloxone distribution education programs. This analysis noted that
these initiatives served a fundamental role in equipping and training people on ways of
responding to the occurrence of an overdose. Sellen and associates established that identifying
overdose, amount of naloxone, effects of stigma, the legal risk associated with responding to
incidents, contributions as conventional first aid, and family as possible facilitators of these
interventions. According to Jawa et al. 2020, to combat opioid overdose in healthcare settings,
incorporating flexible, brief, and effective training can be essential. The study suggests that such
training incorporates practical interventions for health stakeholders at various levels of
education. This research argues that the integration of this education program can equip future
healthcare professionals with essential knowledge for approaching opioid overdose.
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Challenges and Barriers to Implementation
Implementing naloxone distribution education programs often faces various challenges
and barriers that hinder their effectiveness. According to Worthy (2022), one practice problem
includes the inexistence of patient or family education documents that healthcare professionals
can utilize as a guide to inform individuals about opioid risk. According to this study, the lack of
such a document makes it challenging for healthcare providers to educate patients on the
appropriate management of naloxone to avoid opioid overdose, especially in the outpatient
environment. On the other hand, Rudisill et al. (2021) outlined various factors, including
bureaucracy, policy, and processes of an organization as primary barriers. The research further
found that stigma, logistic concerns, reporting issues, and lack of communication, especially
post-distribution, after the effectiveness of these programs. Similar to the research by Rudisill et
al. (2021), Salvador et al. (2020) found that barriers to successfully implementing these
education programs cut across patient, agency, and policy levels. Salvador and associates
established that persistent barriers include receptiveness by the patient, costs related to naloxone,
staff time, and prohibitive regulations. Thakur et al. (2020) is another study that attempted to
identify barriers to these programs. The research proposed that pharmacists are properly placed
to recognize patients at a heightened risk of overdose, distribute naloxone, and guide individuals
on the appropriate usage. However, it established that these professionals are often underutilized
and lack programs that support their roles. Thakur and associates identified that this lack of
training on the part of pharmacists limits their ability to educate individuals, especially those at
risk of overdose.
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Future Considerations
According to Bennett & Elliott (2021), in recent years, naloxone has become a vital
lifesaving overdose antidote. However, this study highlights access and training on naloxone
distribution remains limited in many regions. The research proposes tapping into technology to
increase accessibility and provide education about naloxone distribution. Similarly, Jakubowski
et al. (2019) offer that naloxone distribution programs have traditionally been offered through
harm reduction facilities. Hence, the study suggests the need for finding the optimal way of
deploying such services. These insights are further echoed by Razaghizad et al. (2021). The
review states that these programs are effective in minimizing opioid-associated mortality.
However, the research provides that further high-quality exploration is essential to optimize the
effectiveness of these programs.
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References
Bennett, A. S., & Elliott, L. (2021). Naloxone’s role in the national opioid crisis—past struggles,
current efforts, and future opportunities. Translational Research, 234, 43-57.
Haegerich, T. M., Jones, C. M., Cote, P. O., Robinson, A., & Ross, L. (2019). Evidence for state,
community and systems-level prevention strategies to address the opioid crisis. Drug and
alcohol dependence, 204, 107563.
Jakubowski, A., Pappas, A., Isaacsohn, L., Castillo, F., Masyukova, M., Silvera, R., … &
Bachhuber, M. A. (2019). Development and evaluation of a pilot overdose education and
naloxone distribution program for hospitalized general medical patients. Substance
abuse, 40(1), 61-65.
Jawa, R., Luu, T., Bachman, M., & Demers, L. (2020). Rapid naloxone administration workshop
for health care providers at an academic medical center. MedEdPORTAL, 16, 10892.
Lambdin, B. H., Bluthenthal, R. N., Wenger, L. D., Wheeler, E., Garner, B., Lakosky, P., &
Kral, A. H. (2020). Overdose education and naloxone distribution within syringe service
programs—United States, 2019. Morbidity and Mortality Weekly Report, 69(33), 1117.
Razaghizad, A., Windle, S. B., Filion, K. B., Gore, G., Kudrina, I., Paraskevopoulos, E., … &
Eisenberg, M. J. (2021). The effect of overdose education and naloxone distribution: an
umbrella review of systematic reviews. American journal of public health, 111(8), e1e12.
Rudisill, T. M., Ashraf, A. J., Linn, H. I., Sayres, S., Jeffries, J. E., & Gurka, K. K. (2021).
Facilitators, barriers and lessons learnt from the first state-wide naloxone distribution
conducted in West Virginia. Injury prevention, 27(4), 369-374.
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Salvador, J. G., Sussman, A. L., Takeda, M. Y., Katzman, W. G., Moya Balasch, M., &
Katzman, J. G. (2020). Barriers to and recommendations for take-home naloxone
distribution: perspectives from opioid treatment programs in New Mexico. Harm
Reduction Journal, 17(1), 1-8.
Sellen, K., Markowitz, B., Parsons, J. A., Leece, P., Handford, C., Goso, N., … & SOONER
Investigators. (2023). Considerations for the design of overdose education and naloxone
distribution interventions: results of a multi-stakeholder workshop. BMC public health,
23(1), 888.
Thakur, T., Frey, M., & Chewning, B. (2020). Pharmacist roles, training, and perceived barriers
in naloxone dispensing: a systematic review. Journal of the American Pharmacists
Association, 60(1), 178-194.
Worthy, T. Y. S. A. (2022). Opioid Naloxone Education Clinical Practice Guideline.
Level of Evidence
Author (s) Name
Title of the Article
Level of Evidence
Bennett & Elliott (2021)
Naloxone’s role in the national
Level VI
opioid crisis—past struggles,
current efforts, and future
opportunities
Haegerich, Jones, Cote,
Evidence for state, community
Robinson & Ross (2019)
and systems-level prevention
strategies to address the opioid
crisis
Level 1
8
Jakubowski, Pappas, Isaacsohn,
Development and evaluation of
Castillo, Masyukova, Silvera &
a pilot overdose education and
Bachhuber, (2019).
naloxone distribution program
Level IV
for hospitalized general medical
patients
Jawa, Luu, Bachman & Demers,
Rapid naloxone administration
(2020).
workshop for health care
Level VI
providers at an academic
medical center
Lambdin, Bluthenthal, Wenger,
Overdose education and
Wheeler, Garner, Lakosky &
naloxone distribution within
Kral, (2020).
syringe service programs—
Level IV
United States, 2019
Razaghizad, Windle, Filion,
The effect of overdose
Gore, Kudrina,
education and naloxone
Paraskevopoulos, & Eisenberg,
distribution: an umbrella review
(2021)
of systematic reviews
Rudisill, Ashraf, Linn, Sayres,
Facilitators, barriers and lessons
Jeffries & Gurka, (2021).
learnt from the first state-wide
naloxone distribution
conducted in West Virginia.
Level I
Level VI
9
Salvador, Sussman, Takeda,
Barriers to and
Katzman, Moya Balasch &
recommendations for take-
Katzman, (2020).
home naloxone distribution:
Level IV
perspectives from opioid
treatment programs in New
Mexico.
Sellen, Markowitz, Parsons,
Considerations for the design of
Leece, Handford, Goso &
overdose education and
SOONER Investigators. (2023)
naloxone distribution
Level VI
interventions: results of a multistakeholder workshop
Thakur, Frey & Chewning,
Pharmacist roles, training, and
(2020)
perceived barriers in naloxone
Level I
dispensing: a systematic review
Worthy (2022)
Opioid Naloxone Education
Clinical Practice Guideline
Level VI
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