NUR4169 Nursing Research And Evidence Based Practice
Questions:
Answers:
Evidence based practice in nursing is observed in order to make quality decisions and deliver nursing acre that is based upon the clinical expertise that is related to the combination of the most relevant and recent researches. Evidence based nursing is generally implemented in order to be updated to the most up to date methods of health care delivery (DiCenso, Guyatt & Ciliska, 2014). This has been proved through appraisal of high quality studies and statistically significant research findings. The primary goal of evidence based practice is to elevate the level of improvement in field of the health and safety of patients (LoBiondo-Wood et al., 2013). Here the evidence based practice is focuses on palliative care that can be provided to the older adults suffering from depression especially in the care home setting. A clinical question can be developed from this scenario of evidence based practice using the PICO framework. This PICO helps to easily answer the determined clinical question and it also helps to facilitate the literature search (Kloda & Bartlett, 2013). This paper therefore aims to identify a clinical question from the selected area of evidence based practice of nursing. Using the clinical question the paper will provide a PICO question using the PICO framework. Literature sources retrieved from databases like CINAHL and Medline will be provided in the paper along with the abstract of the article.
The PICO framework is as follows:
P- Patient, Problem or Population
I- Intervention,
C-Comparison or Control, and
O-Outcome
The PICO question that can be structured from the above mentioned scenario is as follows:
“Is cognitive therapy useful to manage depression in the older adults in the care home setting?”
From the above question, the PICO components can be identified as
P (population) – Older adults
I (intervention) – Cognitive therapy
C (comparison) -none
O (outcome) -Management of depression
List of related literature:
Literature related to the selected area of the evidence practice is retrieved through the use of various databases like CINAHL, Medline and Google scholar. The search terms that were used in order to conduct the search consisted of “depression, older adults, cognitive therapy, palliative care, care homes and depression management”. The AND operator was used in order to conduct the search using all the search terms together is order to retrieve the most appropriate literature related to the selected field of evidence based practice. The search was conducted for the papers which were published in English language and between the years 2013 and 2018.
Quantitative research articles-
Article 1
Wagner, B., Horn, A. B., & Maercker, A. (2014). Internet-based versus face-to-face cognitive-behavioral intervention for depression: a randomized controlled non-inferiority trial. Journal of affective disorders, 152, 113-121.
Abstract:
Background and aims
Previous studies have shown that the research that has been conducted has revealed internet-based interventions to have advantageous effects on the management of depression. In spite of this, it is found that there is only mention of few clinical trials in literature that has compared internet-based depression therapy with the face-to-face treatment, which is considered to be equivalent. Therefore this study aims to investigate the treatment outcomes of both these interventions and compare them in terms of depression using a non-inferiority trial of a randomized manner.
Method
62 individuals had participated in the trial who were suffering from depression. Sampling was done randomly and 32 of them were assigned to the intervention group that was therapist-supported, while 30 participants were assigned to face-to-face intervention. The interventions were conducted for a period of 8 weeks which were cognitive-behavioral therapy based principles. Both of the groups has received similar treatment and in the same time- frame and chronological order. Beck Depression Inventory-II (BDI-II) was the primary outcome and the secondary outcome were identified as suicidal ideation, anxiety, hopelessness and automatic thoughts.
Results
There was no significant inter-group difference the intention-to-treat analysis for any of the pre- to post-treatment measurements whether it was online vs. face-to-face group. There were symptoms identified at the post-treatment which showed that there was a comparison before the intervention. The sample size for the online group and for the face–to-face group was considered quite large and the group effect sizes for depression was d=1.27 and d=1.37 respectively. After a 3 month follow up, the results show that in the outline group that remained stable. This is in contrast to the fact that the participants in the face-to-face group showed reduces depressive symptoms even after three months after termination of treatment (t=−2.05, df=19, p<.05).
Limitations
The limitation is posed by the small sample size and it will be important to assess these outcomes in trials that are adequately-powered.
Conclusions
From the study it was concluded that the internet-based intervention for depression was as beneficial as to the face-to-face therapy. However, there was more long term efficacy that was indicated by symptom reduction continued for three months after treatment, and could be only be found for the online group.
Description of data collection
In this study, the data collection is conducted through the method of random controlled trial (RCT). The participants of the survey were in a random manner that was assigned to the therapist supported intervention that is internet based and the face-to-face intervention.
Article 2
Berking, M., Ebert, D., Cuijpers, P., & Hofmann, S. G. (2013). Emotion regulation skills training enhances the efficacy of inpatient cognitive behavioral therapy for major depressive disorder: a randomized controlled trial. Psychotherapy and Psychosomatics, 82(4), 234-245.
Abstract:
The background of the study shows that regulation of the emotional skills are the probable factors that maintain the major depressive disorder (MDD). The study aimed to determine whether integration of the systematic emotion regulation training (ERT) played a role in enhancing the efficiency of the routine inpatient cognitive behavioral therapy (CBT) for MDD.
The method implemented was the prospective randomized controlled trial method that involved participation of 432 inpatients, who met the criteria for MDD and were assigned to receive either routine CBT or CBT enriched with an intense emotion regulation skills training (CBT-ERT).
The results of the study showed that participants in the CBT-ERT condition were associated with decreased depression levels where the response rate was revealed as CBT: 75.5%, CBT-ERT: 84.9%; remission rates – CBT: 51.1%, CBT-ERT: 65.1%. Additionally the participants of the CBT-ERT showed a higher amount of reduction in adverse effects where with the higher increase in the well-being along with the emotion regulation skill, it was particularly relevant for mental health.
In conclusion it was deduced that integration of the strategies that target emotion regulation skills helped in improving the efficacy of CBT for MDD.
Description of data collection
In this study, the data collection is conducted through the method of random controlled trial (RCT). 432 inpatients who met the criteria for MDD were assigned to receive routine CBT or the CBT enriched method with an intense emotion regulation skills training (CBT-ERT).
Article 3
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. American Psychologist, 69(2), 153.
Abstract:
Over the past years it has been perceived that cognitive-behavioral therapy (CBT) has been considered to be the first-line psychosocial treatment for individuals suffering from chronic pain. In order to improve the efficiency of the evidences related to the improvement in pain and other pain related problems which included a wide range of chronic pain syndromes has been derived from multiple randomized controlled trials. CBT has been customized and is found to be helpful in regards of the special population associated with chronic pain in case of children as well as the older adults. The innovations related to the CBT delivery formats involving Web-based and telephone-delivered interventions along with the treatments that are based on the principles of CBT are often delivered by the heath care personnel who show a promise for the problems of chronic pain. The discussed article aimed to review the evidence base for CBT as applied to chronic pain along with the recent innovations related to the targeted population and the methods of healthcare delivery that is offered to CBT population. It also reviews the existing limitations and the gap of knowledge. There are also promising directions for the improvement in efficacy of CBT that is involved in accession of the people who are living with chronic pain.
Description of data collection
In this study, the data collection is conducted through the method of random controlled trial (RCT). Innovations in CBT delivery formats used interventions like Web-based and telephone-delivered intervention and treatments which were based on CBT principles.
Qualitative research articles:
Article 4
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. The Canadian Journal of Psychiatry, 58(7), 376-385.
Abstract:
There was no evidence of meta-analysis that has examined the cognitive-behavioural therapy (CBT) for the adult depression. Therefore a meta-analysis of an updated version has been conducted.
There were studies were identified through searches in a systematic way in bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane library). The studies which were included examined the effects of CBT which were compared with control groups along with other pharmacotherapy and psychotherapies.
There were 115 studies were found to meet the criteria of inclusion. There might have been an overestimation of the true ES that were found to be strong indications for the bias of publication ES after adjustment for bias was g = 0.53). This was also because the higher-quality studies was significantly lower (g = 0.53) than for lower-quality studies (g = 0.90). The difference that existed between the studies of high quality and low quality remained quite significant even after the adjustment of the characteristics of the study in the multivariate meta-regression analysis. There was no such indication so as to the CBT which was more or less effective in comparison to the psychotherapies or pharmacotherapy. There was combined treatment found to be more significant and effective than pharmacotherapy alone (g= 0.49).
No doubt is present about the fact that CBT is an effective treatment for adult depression, although the effects may have been overestimated in most cases. CBT is also the most studied psychotherapy for depression, and thus has the greatest weight of evidence. However, other treatments approach its overall efficacy.
Description of data collection
This study collected data through the systematic searches in bibliographical databases like PubMed, PsycINFO, Embase, and the Cochrane library. Such studies were included which examined the effects of CBT in comparison to the other control groups along with the other psychotherapies and pharmacotherapy.
Article 5
Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical psychology review, 37, 1-12.
Abstract:
In terms of the efficacy of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), the researchers obtained insights so as to the mechanisms underlying their therapeutic effects on psychological outcomes which using the methods of mediation analysis. There was no such study that have systematically reviewed and statistically integrated mediation studies in this field. This study aimed to review the articles systematically according to the literature on mindfulness-based interventions (MBIs). This helps to identify the significant psychological mechanisms underlying MBCT and MBSR’s effects on psychological functioning and wellbeing, and evaluate the strength and consistency of evidence for each mechanism. For the mechanisms that are identified with sufficient evidence, quantitative synthesis using two-stage meta-analytic structural equation modelling (TSSEM) was used to examine whether these mechanisms mediate the impact of MBIs on clinical outcomes. Almost all the reviewed studies of mediation studies have several key methodological shortcomings which come before the robust conclusions related to mediation. However, most of time they provide important groundwork on which future studies could build.
Description of data collection
This study collected data through the systematic reviews through the mediation studies in the literature that were based on the mindfulness-based interventions (MBIs). This was conducted to identify potential psychological mechanisms underlying MBCT and MBSR’s effects on psychological functioning and wellbeing.
Article 6
Normann, N., van Emmerik, A. A., & Morina, N. (2014). The efficacy of metacognitive therapy for anxiety and depression: A meta?analytic review. Depression and Anxiety, 31(5), 402-411.
Abstract:
A comprehensive literature search was conducted which in turn published 16 as well as unpublished studies dependent of the efficacy of MCT, out of which 9 were controlled trials. There were 384 participants considered who were suffering from anxiety or depression. Using a random effects model, the treatment efficacy was determined.
The primary outcome measures showed that the aggregate within?group pre? to posttreatment and pretreatment to follow?up effect sizes for MCT were large (Hedges’ g = 2.00 and 1.65, respectively). The results also revealed that from pre? to posttreatment changes in metacognitions within the group, it was large (Hedges’ g = 1.18) and maintained at follow?up (Hedges’ g = 1.31). It was also perceived that across the controlled trials, MCT was significantly more effective than both waitlist control groups (between?group Hedges’ g = 1.81) as well as cognitive behavior therapy (CBT; between?group Hedges’ g = 0.97).
From the study it was seen that that MCT is effective in treating disorders of anxiety and depression and is superior compared to waitlist control groups and CBT, however it was found that there was requirement in caution for the latter findings. The limitations were posed on the implications of these findings by the small sample sizes and few active control conditions. There was requirement for future studies should include larger sample sizes and also include comparisons of MCT with other empirically supported therapies.
Description of data collection
In order to collect data, a comprehensive literature was conducted in order to search published as well as unpublished studies on the efficacy of MCT.
References
Berking, M., Ebert, D., Cuijpers, P., & Hofmann, S. G. (2013). Emotion regulation skills training enhances the efficacy of inpatient cognitive behavioral therapy for major depressive disorder: a randomized controlled trial. Psychotherapy and Psychosomatics, 82(4), 234-245.
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. The Canadian Journal of Psychiatry, 58(7), 376-385.
DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences.
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. American Psychologist, 69(2), 153.
Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical psychology review, 37, 1-12.
Kloda, L. A., & Bartlett, J. C. (2013). Formulating answerable questions: question negotiation in evidence-based practice. Journal of the Canadian Health Libraries Association, 34(2), 55-60.
LoBiondo-Wood, G., Haber, J., Berry, C., & Yost, J. (2013). Study Guide for Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.
Normann, N., van Emmerik, A. A., & Morina, N. (2014). The efficacy of metacognitive therapy for anxiety and depression: A meta?analytic review. Depression and Anxiety, 31(5), 402-411.
Wagner, B., Horn, A. B., & Maercker, A. (2014). Internet-based versus face-to-face cognitive-behavioral intervention for depression: a randomized controlled non-inferiority trial. Journal of affective disorders, 152, 113-12
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