Example Of Essay On Research And Evidence For Practice Ghs5841
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I have identified a clinical issue in my place of employment of direct relevance to my nursing practice. The question which I plan to address is “what has been proven to be as effective as antidepressants in the treatment of depression?” I will construct a PICO for my question and propose a strategy for a literature search.
According to Carter (2013), the latest health “snapshot” of the 33 OECD (Organisation for Economic Cooperation and Development) nations has revealed that Australia is now the highest prescriber of antidepressant medications.
In conversation with a general practitioner at my place of work, (Dr R), he indicated time pressures placed on GPs may be a factor.
He feels that GPS be should be able to utilize a wider variety of treatment modalities. However, when they can only spend 8 to 12 minutes with each patient this creates a dynamic that produces over reliance on prescription anti-depressants. This time constraint contributes to patients being provided insufficient or no information on alternatives to help guide their treatment choices (Carter, 2013).
In my nursing practice I have noticed an increased number of patients being prescribed antidepressants with little understanding of all the effective treatment choices available. It is part of the Mental Health Nurses role to deliver evidence based
psychoeducational interventions, including information about effective treatments, side effects, expected duration of treatment and interactions (Tousi, et al., 2013).
I have decided that in order to provide beneficial psychoeducation I require a greater understanding of what has been clinically proven to be as effective or nearly as effective as antidepressants in the treatment of depression (Colom, 2011).
My expected outcome is to develop an increased knowledge of proven and safe effective modalities in treating a depression. It is postulated that by increasing the patient’s awareness of effective treatment, the possibility of self-management and relapse prevention will be improved. This psychoeducation approach may improve the patient’s ability to make a more informed decision regarding the benefits of adherence, compliance and assist a deeper therapeutic relationship (Colom, 2011).
PICO format utilized to develop an answerable, researchable question (Melnyk & Fineout-Overholt, 2011).
POPULATION: Patients with depression
PROBLEM: Current population has insufficient or no information on options to help guide their choice in treatment for depression
INTERVENTION: Educational explanation of treatments to manage depression other than antidepressants.
COMPARISON: No educational explanation
OUTCOME: Increase my awareness of proven effective treatment modalities other than prescription antidepressants and apply this knowledge in my practice (Melnyk & Fineout-Overholt, 2011).
I propose to utilize a strategy based on the Manchester university guidelines (The University of Queensland, 2014). There are four key stages which contributed to an effective subject search. There were –
Step 1 – Defining the subject in terms of keywords.
Step 2 – Identifying information sources.
Step 3 – Searching information sources using keywords.
Step 4 – Download relevant information.
Step 1 involved giving considerable thought to the question under consideration, I also utilized colleagues at work as a sounding board to generate ideas, the aim was to generate keywords that fully directly related to the question and that were appropriate to be entered into a database search engine (The University of Queensland, 2014).
In order to retrieve as much information as possible consideration was given to synonyms, alternative terminology and variation in word endings.
Synonym e.g. efficacy or effectiveness.
Alternative terminology e.g. complementary medicine vs alternative medicine.
Variation in word ending e.g. use * to retrieve variation in the ending
Step 2 involved identifying information sources, key databases accessed through the Monash (The University of Queensland, 2014) library such as:
Joanna Briggs Institute
These key databases were utilized to conduct the keyword searches.
Step 3 involved utilizing keyword terms generated in step 1. It was noted that the majority of databases have a standard search interface which allows you to enter your keywords. Keywords were entered into the Cochrane database (Cochrane, 2007).
The Cochrane database is the words best database for reviewing comparative research studies, due to my questing being restricted to proven therapeutic interventions the Cochrane database was chosen in order to provide me the most rigorous information (Cochrane, 2007).
There are many different ways to search databases, the method I chose was keyword searching into search field to capture literature related to my topic.
Once logged into the Cochrane database through the Monash portal, the Advanced Search option was selected.
Refer to table 1.
Generated keywords that related to the question were typed into the search engine. The Cochrane library uses auto pluralization therefore the truncation symbol was not required. Words entered into the search were:
The search resulted in 810 related articles. Refer to table 2:
In order to narrow down my search I clicked on additional limits option on Table 2, which directed me to search limit options displayed in table 3 below.
Narrowing down my search involved choosing a search limit by clicking a “select” box and selecting the limits that I required by clicking the checkboxes and choosing from the pull down menus. Once this was done “limit search” was clicked at the bottom of the page, the search was then narrowed down to 7 articles.
On the search terms antidepressants, alternatives, treatment and effective articles were only selected that had deep relevance to my research question.
Step 4: Once I located the articles that matched my information needs, downloading was a relatively simple process. Once clicking on the “systemic review full text option. Refer to table 4.
Options displayed on the right hand side of page titled “article tools” this provided the option to download articles in pdf or html format- pdf provides an exact representation of how the article appears in the printed version of the journal which includes diagrams and photographs ect. There are also options to print or email the article to my email account. Refer to table 5.
Evaluating the quality of my information was done through the CARTS check. Meaning the information was to be credible, audience (target), reasonable,/relevant, timely and supported.
In order to keep records of the searches carried out in order avoid having to repeat searches again, various ways to document any searches could be carried out (Cochrane, 2007).
The method I used was to copy and paste screens from the database into a word document.
Selecting the required image that I wanted to capture from the Cochrane database.
Click the print screen button on my keyboard
Opening a word document
Holding down the control key and then pressing the v key
The screen shot was then copied to the word document
The screen capture was then labelled with the name of the database used along with the date of the preformed search.
Carter, L. (2013). OECD snapshot ranks Australia second in world in anti-depressant prescriptions. CQ Health access. Retrieved from http://www.abc.net.au/news/2013-11-22/auochrane,stralia-second-in-world-in-anti-depressant-prescriptions/5110084
Cochrane. (2007). How to develop a search strategy for a Cochrane Review. Cochrane Haematological Malignancies Group, Naumann, 1-10. Retrieved from http://chmg.cochrane.org/sites/chmg.cochrane.org/files/uploads/How%20to%20develop%20a%20search%20strategy-support-manual.pdf
Colom, F. (2011). Keeping therapies simple: psychoeducation in the prevention of relapse in affective disorders. The British Journal of Psychiatry 198(5).
Melnyk, B.M. and Fineout-Overholt. (2011). E: Evidence-Based Practice in Nursing & Healthcare. Philadelphia: Lippincott Williams & Wilkins.
Ross, J. (2014). Safe Alternatives to Antidepressants Prove Effective: Evidence. Northern California: The Nutritional Therapy Institute.
The University of Queensland. (2014). Create a search strategy. UQ Library. Retrieved from https://www.library.uq.edu.au/how-to-guides/create-search-strategy
Tousi, M.F., Baes, C.V., Comacho, F.R., Tofoli, S.M., and Jurena, M.F. (2013). Effectiveness of psychoeducation for depression: a systematic review. Aust N Z J Psychiatry 11(47): 1019-1031.
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