Assignment: Evidence-Based Practice Research Paper
Assignment: Evidence-Based Practice Research Paper
Organizational culture is a critical determinant of successful implementation of evidence-based practice in any health organization. It is therefore important that nurses and other healthcare providers undertake an assessment of their organizations to determine their readiness to support evidence-based practice. The tool for evidence-based practice that was utilized for this task was obtained from the book by Cameron and Quinn (2011). The tool comprises of now and preference questions. The now questions examines the current situation of the organization while preference questions examines what an ideal organization should be. The average scores for the now questions was 75% out of 100%. The average score for the preferred questions was found to be 85% out of 100. The results show that the organizational culture in our hospital can support the implementation of evidence-based practice to promote quality nursing care.
The survey tool pointed out some of the facilitators as well as barriers to evidence-based practice in our organization. Some of the facilitators include leadership support, teamwork, trust, and encouraging of innovation and risk taking behaviors in the organization. It also included aspects such as the use of management styles that encourage independence and leadership that focuses on mentorship, nurturing, and facilitation of knowledge and skills development among the staffs. The survey identified potential barriers to the implementation of evidence-based practice, which include lack of organizational support, staff low-level of awareness towards evidence-based practice, and the high workload in the organization. Therefore, despite the organization being ready to implement evidence-based practice, it should explore different ways in which it can address the potential barriers to successful use of evidence-based practice by its staffs.
Section B: Proposal/Problem Statement and Literature Review
The refined PICOT statement from the proposed intervention is as follows:
In African-American patients with major depressive disorder, will the use of combined intervention involving cognitive behavioral therapy and antidepressants reduce severity of complications when compared to the use of antidepressants alone within 12 months?
The need for this intervention arose from two factors. Firstly, evidence has consistently shown that individuals from African-American backgrounds are least affected by major depressive disorder. However, the complications associated with the condition among them are high. As a result, it increases the need for a study examining effective methods of managing the disorder among this population. Secondly, the management of major depressive disorder relies mainly on the use of antidepressants. However, the use of non-pharmacological interventions has also proven effective in managing the disorder. Therefore, it raises the need to investigate the outcomes associated with the combined therapy when compared to monotherapy in the treatment of the disorder.
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Some studies have been conducted in the past to determine the efficacy of combined therapy vs. monotherapy in the management of
major depressive disorder and reduction of the severity of symptoms associated with the disorder. A meta-analysis by Boschloo et al., (2019) explored the efficacy of using antidepressants vs. cognitive behavioral therapy in treating depression. The researchers examined results reported in 17 randomized controlled clinical trials, which investigated the efficacy of the two treatments. Symptoms that include depressed mood, feelings of guilt, suicidal thoughts, and general somatic symptoms were improved with the use of medications and cognitive behavioral therapy. However, this research is associated with the limitation of failing to use study participants in investigating the topic. Despite this weakness, the researchers recommended the use of the combined therapy since it could result in improved outcomes with the treatment.
Corruble et al., (2016) conducted a study that examined the effectiveness of telephone-administered psychotherapy with antidepressant in the treatment of major depressive disorder. The researchers used 221 adults with major depressive disorder who were assigned randomly to eight sessions of weekly treatment with psychotherapy and antidepressants. The control group was administered with intensive clinical management of the disorder using agomelatine. The outcomes showed that there was a high response rate with the use of the combined treatment when compared to antidepressants alone. Despite the study having used human subjects, it had the weakness of being conducted over a short period (Corruble et al., 2016). Kamenov et al., (2017) conducted a meta-analysis to examine the efficacy of pharmacotherapy, psychotherapy, and their combination on quality of life as well as functioning in patients with depression. The researchers used 153 outcome trials that involved 29, 879 participants. The outcomes of the review showed that combined therapy has significant health outcomes as evidenced by reduction in severity of the symptoms of the disorder as well as enhanced quality of life (Kamenov et al., 2017). While this study did not use human subjects, its utilization of many trials as its source of evidence raises the credibility of its findings. According to Kamenov et al., (2017), few clinical trials have been conducted to examine the effectiveness of the combined therapy in the treatment of major depressive disorder. As a result, this proposed intervention will bridge the gap in evidence on the topic.
In order to formulate your evidence-based practice (EBP), you need to assess your organization. In this assignment, you will be responsible for setting the stage for EBP. This assignment is conducted in two parts: an organizational cultural and readiness assessment and the proposal/problem statement and literature review, which you completed in NUR-550.
Section A: Organizational Culture and Readiness Assessment
It is essential to understand the culture of the organization in order to begin assessing its readiness for EBP implementation. Select an appropriate organizational culture survey tool and use this instrument to assess the organization\’s readiness.
Develop an analysis of 250 words from the results of the survey, addressing your organization\’s readiness level, possible project barriers and facilitators, and how to integrate clinical inquiry, providing strategies that strengthen the organization\’s weaker areas.
Make sure to include the rationale for the survey category scores that were significantly high and low, incorporating details or examples. Explain how to integrate clinical inquiry into the organization.
Submit a summary of your results. The actual survey results do not need to be included.
Section B: Proposal/Problem Statement and Literature Review
In NUR-550, you developed a PICOT statement and literature review for a population quality initiative. In 500-750 words, include the following:
Refine your PICOT into a proposal or problem statement.
Provide a summary of the research you conducted to support your PICOT, including subjects, methods, key findings, and limitations.
General Guidelines:
You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.
Dementia is a life-threatening condition typically characterized by dysfunction in intellectual domains of human existence including language, cognition, memory, and visuospatial ability. On average, 10 percent of adults aged 65 and above are suffering from dementia. Interestingly, 50 percent of elderly persons aged 90 and above are believed to have acquired this syndrome. Recent studies add that this condition poses catastrophic challenges to primary care physicians (PCPs) in the modern healthcare sector (American Diabetes Association, 2017). As the larger portion of the global population, particularly in the Asian and Western hemispheres, continue to age at unprecedented rates, the number of people suffering from dementia is bound to increase. At the moment, the global tally of demented patients lies at 24 million, and it is expected to increase to 52 and 81 million by 2030 and 2040 respectively. Such an alarming trend has been affirmed by the World Health Organization’s sentiments on Alzheimer’s, a condition rightly categorized under dementia. According to this body, Alzheimer’s is highly likely to become the leading factor behind disability among the elderly. In the United States alone, the population affected by this phenomenon has reached at least 5.3 million, and it is projected to triple within 50 years.
Apart from the noteworthy risk of deaths, the high prevalence rates have a substantial impact on the economic burden on both the patients’ families and the nations at large. In a recent clinical survey, Judge, et al. (2019) found that dementia costed between 100 and 150 billion dollars on an annual basis. As devastating as it sounds, this figure is on a steady increase due to the number of elderly people in the country. A somewhat similar trend has been witnessed in Europe, Wolters and colleagues (2020) argue that the region spends approximately 104 billion dollars in national care interventions. Such initiatives are necessary considering the fact that some dementia patients experience cognitive challenges that can be reversed through early diagnosis and therapeutic solutions. In attempt to promote efficacy in the resolution of such cases, clinical practitioners are urged to reflect on the role of the primary care physicians. Judge, et al. (2019) define PCPs as the bridge between patients and the healthcare system. They are the professional care providers that equip primary care providers (mainly patients’ families/guardians) with essential information and skills for the management of their patient in unmonitored settings such as homes.
On this note, this paper proposes a research project that investigates the decisive role of primary care physicians on the recovery process of patients suffering from dementia. For the sake of clarity, discussion on these practitioners will be tethered around their approaches to office-based encounters among all stakeholders including the patients, family care, diagnosis, management, emotional support, and service linkage. This project will enhance both the researcher’s and the audience’s grasp of this matter while responding to the question below:
Do care provider practice partners have positive impacts on the treatment and management of dementia among elderly patients?
Problem Statement
Primary care treatment standards for dementia patients mandate practitioners to ameliorate cognitive and non-cognitive symptoms while maintaining the patient’s quality of life. As a rule, this process is highly dependent on the practitioner’s capacity to support and educate the patient and/or his family on key disease management factors including emotional stability and physical safety. Judge et al. (2019) add that commendable care necessitates connections between patients, families, referral medical specialists, and social/communal services. Unfortunately, the patients’ cognitive decline triggers behavioral disturbances that result in increased disability and caregiver burnout, burden, and eventually, anxiety/depression. These challenges are magnified by high clinical costs due to early institutionalization. These issues include increased reliance on the patients’ families, role shifting from curing to caring, behavioral and biological complexity of the condition, and insufficient knowledge and resources necessary for treatment.
Dementia is a largely misunderstood phenomenon. Such a bold claim is deeply embedded on common industry trends including the lack of concise diagnostic tools and the complex interactions between the primary care physicians and the patients as well as their families. In the wake of such a realization, practitioners should have a lucid understanding of how their practice impacts the outcomes of care despite the systemic inefficiencies. They should know how to leverage resources and skills at their disposal to improve the type of care delivered to dementia patients. As highlighted earlier, physicians’ roles in dementia treatment are usually heightened during their interaction with patients, their families, and the healthcare system (American Diabetes Association, 2017). This implies that they should foster clarity throughout the diagnosis, treatment, and management phases. Fundamentally, this process must involve the provision of emotional support and service linkage. By now, it is obvious that physician care practice is at the backbone of dementia treatment and management. Therefore, these practitioners should know how to capitalize on what they have to achieve what they have not. A qualitative exploration of physician sentiments on this matter will go a long way in affirming the preceding hypothesis.
References
American Diabetes Association. (2017). Standards of medical care in diabetes—2017 abridged for primary care providers. Clinical diabetes: a publication of the American Diabetes Association, 35(1), 5.
Judge, D., Roberts, J., Khandker, R. K., Ambegaonkar, B., & Black, C. M. (2019). Physician Practice Patterns Associated with Diagnostic Evaluation of Patients with Suspected Mild Cognitive Impairment and Alzheimer’s Disease. International Journal of Alzheimer’s Disease, 2019.
Wolters, F. J., Chibnik, L. B., Waziry, R., Anderson, R., Berr, C., Beiser, A. S., & Dartigues, J. F. (2020). 27-year time trends in dementia incidence in Europe and the US: the Alzheimer Cohorts Consortium. Neurology.