Evidence-Based Practice and Stimulants

This assignment delves into the use of stimulants for academic performance enhancement. It focuses on evidence-based practices surrounding this topic, analyzing their impact on individuals with ADHD and addressing the risks associated with non-medical use. The student is tasked with applying the PICO method to research a clinical question related to stimulant use and sharing findings with peers, emphasizing the importance of medical guidance in such situations.

Running Head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

1NURSING
Introduction
The essay deals with the case scenario of Wasim, who is in a dilemma regarding the use
of stimulants for academic performance as advised by his friends. In response to the case study,
the essay aims to address the PICO question developed by Wasim, which is “Do stimulants
increase academic performance in university students?” Finding evidence to this question will
help Wasim to make clinical decision. The use of the latest research studies about the problem
area conscientiously, is referred as evidence-based practice. The essay aims to evaluate the two
pieces of evidence pertaining to the clinical area and discuss barriers to implement the evidence.
PICO model involves the formulation of well-built clinical foreground question. The four
components of the PICO question are - “P (population/problem), I (Intervention), C (comparison
or placebo), and O (Outcome)”. In PICO question developed by Wasim university students are
population, the stimulants use is intervention, and the academic performance enhancement is the
outcome measured. These components help to identify specific literature evidence about the
effect of the stimulants (Ahadi & Habicht, 2017).
Part A
1. Hildt, E., Lieb, K., & Franke, A. G. (2014). Life context of pharmacological academic
performance enhancement among university students–a qualitative approach. BMC
medical ethics, 15(1), 23.
Authorship

2NURSING
Three authors from different professional backgrounds collaborated in the first qualitative
research paper titled “Life context of pharmacological academic performance enhancement
among university students”. The first Author, Elisabeth Hildt, is professor of philosophy and
director of the Centre for the Study of Ethics in the Professions at Illinois Institute of
Technology”, where her research focuses on philosophical and ethical issues in neuroscience,
most significantly the field of cognitive enhancement. The second Author, known as Professor
Klaus Lieb, is the Director of the Department for Psychiatry and Psychotherapy at Mainz
University. The third author Andreas Günter Franke, works as a trainee in Department for
Psychiatry and Psychotherapy at Mainz University (Hildt et al., 2014). Their qualification gives
the confidence that the results are reliable. Moreover, the researchers obtained ethics approval
for the study from local committee. It can be interpreted that the ethical issues were considered.
It is evident that the research is well conducted.
Aims
The study aimed at reducing the gap concerning the empirical data related to the
enhancement of the academic performance. As there is insufficient literature about contextual
factors of the stimulants use and the associated real world effects on the academic outcomes, the
aims and objectives of the study seems justified. As per the literature review conducted by the
author, it is unclear if the stimulants are used for cognitive and academic performance
enhancement. It is unclear if it can also serve any other purpose. In this context, the author has
well supported the background and rational for the study supporting with relevant literature.
Design

3NURSING
The author has selected qualitative research methodology. For the data collection, face-
to-face interview is used as instrument that contains open-ended questions. The interviews are
based on semi-structured interview guidelines. A sample size of 18 people was included. As per
inclusion criteria, only participants involved in non-medical use of stimulants for academic
performance improvement were involved. To get better insights of the participants’ opinions,
values and perception, open-ended questions in qualitative interview is justified. It will help
understand the cause underlying the behaviour. The qualitative study will help generate ideas for
improvement by studying the impact of stimulants in broad context (Mertens, 2014).
Findings
As per the study results, the main reason for administering the stimulants is to increase
the memorising power and cope up with the academic pressure. The results can be interpreted
that the improvement in academic performance due to stimulants is not an isolated performance.
The sole target of these smart drugs is not the improvement in cognitive functioning. It is also
integrated into the multifaceted context of life, which signifies its crucial relevance. In addition
to improvement in the studies, the students can better cope with the academic curriculum and
balance it with time off. Thus, it appears to be advantageous for them. It can be concluded that
the study aims are achieved.
Strength and weakness
The credibility of the research is realised from their details given in the paper that
includes work experience. Authorship determines the strength of the paper as it ensures that the
authors have expertise to conduct research in this domain (LoBiondo-Wood & Haber, 2017).
Thus, there may be no conflicts of interest about the findings considering the expertise,

4NURSING
qualifications, and affiliations. This adds to the merits of the paper. The need of the study is
justified as stimulants use (illicit or prescription) among university students is less explored and
the study wants to explore the same in broader context (O’Brien et al., 2014).
The research methodology is justified considering the aim of the strength of the paper. It
will help solve the complex problem by breaking into manageable parts. The complexity refers
to understanding the interaction of the participants with the stimulants to achieve the university
academic goals. As this context is not clear, the qualitative study would be useful to explore the
area and link with the mechanisms (Jensen et al., 2016). The findings meet the research aims.
The weakness of the study lies in discrepancies in the qualitative data that was obtained
from the interview. There are differences in the subjective experiences of the participants and the
objective academic outcomes. Very less participants were used and is major drawback that may
hamper the validity and reliability of the data. There is no sufficient details on triangulation
process in data analysis. Due to self-selection of participants, there is a chance of potential bias
(McCusker & Gunaydin, 2015).
2. Munro, B. A., Weyandt, L. L., Marraccini, M. E., & Oster, D. R. (2017). The relationship
between nonmedical use of prescription stimulants, executive functioning and academic
outcomes. Addictive behaviors, 65, 250-257.
Authorship
In the quantitative study four authors from different professional backgrounds
collaborated in the quantitative research paper titled, “The relationship between nonmedical use

5NURSING
of prescription stimulants, executive functioning and academic outcomes”. The first author,
Bailey A. Munro, and second author, Lisa L. Weyandt, works at University of Rhode Island,
United States. The former is a corresponding author associated with the Interdisciplinary
Neuroscience Program. The second author works in the department of psychology as professor.
The third author, Marisa E. Marraccini, works at “Alpert Medical School of Brown University,
and is associated with “Bradley Hasbro Research Center, Rhode Island US”. The fourth author,
Danielle R. Oster also works at “University of Rhode Island, United States” in the department of
psychology as a professor (Munro et al., 2017). It can be interpreted that the research is well
conducted. Therefore, there might not be any discrepancies concerning study findings as the
National Centre for Research Resources of the National Institutes of Health supports the data.
Aim
The study has clear aim that is to determine the relationship between the “nonmedical use
of prescription stimulants or NMUPS and Executive functioning among the college students”.
The author justified the aims and objectives of the study by supporting with relevant studies in
this area. Among the college students, the NMUPS has been found to be a burning problem as
they are attracted by the improvement in executive functioning and academic performance
enhancement (Maier & Schaub, 2015). Executive functions relate to goal-directed behaviour,
planning skills, cognitive flexibility and self-regulation. When these functions are absent in a
person, it leads to poor performance in academics as per literature review. It may cause risk
behaviour among students. In this context, the hypothesis developed by the author seems to be
justified. The hypothesis is - students may take NMUPS to overcome the executive functioning
deficits for academic success. The other hypothesis also seems justified, which is NMUPS may
moderate the relationship between executive functioning and academic performance.

6NURSING
Design
Quantitative research methodology is selected for this research study, and the data is
collected through survey questionnaire. For this study, 308 university students were selected.
The study setting includes six public universities in US from different regions. For a psychology
research, the methodology is justified. Data was analysed for statistical significance to ensure
validity.
Findings
As per Munro et al. (2017), the rate of use of NMUPS, was higher among university
students with executive function deficit than without deficit. The advantage of the stimulants as
interpreted from the study is the improvement in the executive functioning skills. It acts as
driving force for the student’s NMUPS. Therefore, the first research hypothesise is accepted.
Further, students with the self-reported deficit in executive function also showed non-medical
use of use of stimulants. However, the second hypothesis cannot be fully accepted as NMUPS
did not moderate the relationship between “executive function and grade point average”.
Significantly, poor grade point average was observed in the participants with deficit in the
executive function skills.
Strength and weakness
These authors are highly qualified to research about human cognitive function. No
conflict of interest seems to be present as per the authorship of the article and is the strength of
the paper (LoBiondo-Wood & Haber, 2017). It would have been more convincing if author
mentioned details on the ethics approval. Considering the work experience and academic
qualifications the credibility of the research is evident. Further, the arguments and goals in the

7NURSING
paper are well justified with the supporting literature. The need of the study to identify the
university stud at risk of taking NMUPS is justified. In this context appropriate hypothesis was
developed. Necessary interventions can be developed to prevent this issue.
Surveys are helpful to obtain the self-report data from the participants. Further,
conducting the interview for large sample size would be impractical. Since the research has
broad goals, the survey will help assess the feelings, thoughts and opinions to generate quick
data (Mertens, 2014). This is the strength of the paper and the results were statistically
significant making it reliable. Surveys are useful instrument and are right option for collecting
the self-report data in psychology related research. It is justified when research has broad goals
and constitutes strength of research (Anderson et al., 2015).
The weakness of the study comes from use of convenience sampling method. Using the
sample in proportionate number may have eliminated the limitations related to generalisability
of the findings (Munro et al., 2017).
Part B
As per the PICO question developed by Wasim, the literature evidence showed that
stimulants increase the academic performance by enhancing the executive functions in university
students. However, there are various barriers to the implementation of the research evidence. In
the case of Wasim, it may be harmful using this evidence for personal use. In healthy
individuals, no stimulants or drugs may be safe for cognitive functioning (Maier & Schaub,
2015). Irregular use may cause adverse reactions. Misuse of prescription has been found to have
unfavourable consequences. Pharmacological neuroenhancement is associated with ambiguous
effects although it helps to cope up with stress and studies. The given PICO question does not

8NURSING
measure the negative aspects such as consequences of the illicit use of smart drugs. The PICO
question can be modified in future studies to compare the use of stimulants medically and non-
medically. Thus, there is a need of further evidence without which it is difficult for Wasim to
decide on using the stimulants for academic enhancement.
Lack of the evidenced-based clinical guidelines is added disadvantage for nurses,
clinician and patients to advocate the use of stimulants for university students. Further, barriers
may include lack of awareness among the patients about the misuse of drugs and adverse
reactions. Size and complexity of research are the other barriers to evidence-based practice
implementation. Qualitative studies do not give definite concluding evidence so Wasim may not
be sure about using stimulants. These studies only give subjective evidence. Use of survey
includes underreporting of data due to sensitive questionnaires. Quality of the evidence is
hampered because of bias due to personal response. Social desirability cannot be ruled out in
questionnaire (Stavor et al., 2017). It may be difficult for Wasim to rely on the results of the
quantitative studies for use of stimulants.
Conclusion
In conclusion, PICO is the useful and effective method for inquiry into health care. The
evidence obtained from the critique of both the articles is that the use of stimulants by university
students increases the academic performance. It highly benefits people diagnosed with ADHD.
Executive functions can be enhanced by the stimulants. Considering the case scenario of Wasim,
it would not be effective for him to use non-medically. Wasim should share the evidence
obtained by PICO question with his friends so that they prefer medical use of these stimulants
and refrain from non-medical use. The rationale for choosing the PICO process is justified as it is

9NURSING
the systematic process of searching the evidence to solve the clinical questions (Richardson et
al., 2017). In conclusion the PICO method is the effective one to systematically search evidence
for solving clinical problems (Richardson et al., 2017).

10NURSING
References
Ahadi, N. J., & Habicht, R. J. (2017). Incorporating Evidence-Based Medicine into Your Daily
Life. In Hospital Medicine (pp. 85-94). Springer International Publishing.
Anderson, D. R., Sweeney, D. J., Williams, T. A., Camm, J. D., & Cochran, J. J. (2015). An
introduction to management science: quantitative approaches to decision making.
Cengage learning.
Hildt, E., Lieb, K., & Franke, A. G. (2014). Life context of pharmacological academic
performance enhancement among university students–a qualitative approach. BMC
medical ethics, 15(1), 23.
Jensen, C., Forlini, C., Partridge, B., & Hall, W. (2016). Australian university students’ coping
strategies and use of pharmaceutical stimulants as cognitive enhancers. Frontiers in
psychology, 7.
LoBiondo-Wood, G., & Haber, J. (2017). Nursing Research-E-Book: Methods and Critical
Appraisal for Evidence-Based Practice. Elsevier Health Sciences.
Maier, L. J., & Schaub, M. P. (2015). The use of prescription drugs and drugs of abuse for
neuroenhancement in Europe. European Psychologist.
McCusker, K., & Gunaydin, S. (2015). Research using qualitative, quantitative or mixed
methods and choice based on the research. Perfusion, 30(7), 537-542.
Mertens, D. M. (2014). Research and evaluation in education and psychology: Integrating
diversity with quantitative, qualitative, and mixed methods. Sage publications.

11NURSING
Munro, B. A., Weyandt, L. L., Marraccini, M. E., & Oster, D. R. (2017). The relationship
between nonmedical use of prescription stimulants, executive functioning and academic
outcomes. Addictive behaviors, 65, 250-257.
O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for
reporting qualitative research: a synthesis of recommendations. Academic
Medicine, 89(9), 1245-1251.
Richardson, A., Yarwood, J., & Richardson, S. (2017). Expressions of cultural safety in public
health nursing practice. Nursing inquiry, 24(1).
Stavor, D. C., Zedreck-Gonzalez, J., & Hoffmann, R. L. (2017). Improving the use of evidence-
based practice and research utilization through the identification of barriers to
implementation in a critical access hospital. Journal of Nursing Administration, 47(1),
56-61.