Evidence-based Practice In Nursing And Midwifery

Importance of evidence-based practice in patient-centered care

Evidence based practice is an evolving field when it comes to nursing and the health professionals. Evidence based practice is dependent on the quality and maintenance of its implementation when it comes to the nursing. Evidence based practice or EBPs is involved in significant type of nursing practice and special education which would involve various fields of nursing practice, science and healthcare transformation (Stevens, 2013). This includes a schematic formation of data collection and observatory knowledge. According to World Health Organization or WHO it is said that evidence based practice can emphasise the process of understanding the evidence. Furthermore, there evidence based practice in nursing and midwifery in specific regions could buttress the health and education policy members (World Health Organization, 2019). According to Nursing and Midwifery Board of Australia, the nursing practice of a registered nurse should be or patient centred care and therefore, evidence based practice can provide a curative, informative, preventive and supportive enviroment(Nursing and Midwifery Board of Australia,2019). For the critical appraisal tool five articles were evaluated and analysed, and the assignment aims to discuss whether the research paper can be applied for nursing and midwifery practice to the patient in case of depression. 

In nursing practice evidence based practice or (EBP) have two important tools which are Critical Appraisal tools and reporting guidelines (Buccheri&Sharifi, 2017). Depression is a mental health disorder in which the patient loses interest in daily activities accompanied by sadness. This can affect both psychological as well as physiological aspect of the person. In the first paper by Gilbody et al., (2015), the author has targeted depression which is one of the most common reason a patient consults the general practitioners or GP and cognitive behavioural therapy is a thriving field of brief psychoanalysis therapy for depression. Hence, in this research parallel randomized trial was done to study the effect of computerised Cognitive Behavioural Therapy (cCBT). This research was based on the REEACT trial or Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy which was appraised by the UK technology in 2006 as a commercially develop package for cCBT,   .The computerized Cognitive Behavioural trial was conducted on the adults who had symptoms of depression. The paper has taken account for the randomised trial for four months, on the commercially produced cCBT programme which was “Beating the Blues” and a free cCBT programme “MoodGYM”. Though this type of computerised cognitive behavioural therapy is a new field than the conventional GP care, the study limitation proved that there was 24% drop of participants from the program and it was not as effective as the usual GP care. The following results were found (odds ratio 1.19 (95% confidence interval 0.75 to 1.88) for Beating the Blues v usual GP care; 0.98 (0.62 to 1.56) for MoodGYM v usual GP care). This research study is evidence to present nursing practice that the computerized cognitive behavioural therapy is not superior to the GP care and hence, a person fighting with depression should consult a general practitioner. 

Research on Computerized Cognitive Behavioral Therapy

In the second paper, the primary aim was to understand the effectiveness of three interventions in case of depression, was which was researched by Hallegran et al., (2015). The three interventions were: physical exercise, internet based cognitive behavioural therapy or ICBT and Treatment as usual or TAU. The secondary aim of the study was to understand the changes in self-related work capacity. The study consisted of the total of 946 patients who had the symptoms from mild to moderate depression. The study duration was about three months and the study design was RCT or Random Control Trial for the relative comparison of exercise, ICBT and TAU. The patients were recruited on the basis of Patient Health Questionnaire above 9 (PHQ-9) and were above 18 years old. The sample size was sufficient to address the trial, where women were 73%. The exclusion criteria was based on the age (<18), suffering somatic illness or subjected to the drug abuse. The study showed that physical exercise and ICBT is more effective than the TAU. From the literature survey of the research paper there were papers which indicated that TAU was not an effective treatment. There are numerous evidences about the effect of exercise’s influence on the mental and development, the research paper confirms the effect of exercise on mild to moderate depression induced patient. There are numerous strengths in this paper and this can be brought up in to the nursing and midwifery practice and the physical exercise and ICBT can be advised to the patient with mild to moderate depression with response rate of 78%. However, there various limitations to the paper, there are various factors like the social determinants of the health such as age, education, employement and others which might also affect the emotions of a person. However, from this evidence, the patients can be advised to go for routine exercise and self-efficacy.

The third research paper is based on the basis of Mindfulness based cognitive theory or MCBT which showed efficacy in case of major depression (Chisea et al., 2015). Several links to the efficacy of mindfulness with depression have been found which is also used in case of emotional regulation (Desrosiers et al., 2013). This study was conducted on the 106 subjects who did not achieve the remission in spite of 8 weeks of anti-depressant treatment hence has major depression or MD. The randomized trial was done for over 26 weeks of period with the interval of 4 weeks. This trial was effective and has by the Hamilton Rating Scale for Depression (HAM-D) and the Beck Depression Inventory –II (BDI). The score associated with the mindfulness and the quality of life, and measurement of anxiety showed better score with higher improvement over psycho education group which was treated as control group. Therefore, it could be understood that in spite of the long term procedure the treatment was evident to be effective. However, the research paper had few shortcomings as it had small sample size. The evidence showed that the practice of mindfulness cognitive theory has efficacy on the basis of long term period. The strength of this research paper is that this study was analysed over a long period of time, which is approximately 6 months. The studies which available prior to this paper lacked methodology as well as lacked control groups. The practice of mindfulness can be evidently found in previous research article and this article has the evidence of improvement in treating Major depression or MD and thus can be introduced to practice, however, the introduction to mindfulness along with cognitive therapy programs in case of major depression need proper nursing intervention, care and consideration of the patient’s present state of body and mind. 

Effectiveness of Physical Exercise and Internet-based Therapy in Treating Depression

The fourth article is based on comparison between the cognitive therapy with the anti-depressant medication and only with antidepressant (Hollon et al., 2014). The sample size was about 452 participants out of which 227 were randomized with cognitive therapy along with combination of antidepressant medication or ADM. The remaining group which were around 225 randomized participants were subjected to anti-depressant drug alone. The study was based on the outpatients, and out 452 participants 170 participants recovered who were given combined treatment and 148 participants recovered. This research paper proved the efficacy of combined cognitive therapy along with ADM in participants having major depressive disorder. The strength of the paper lies on the length of therapy (which was about 42 months), given to the patients as well as the on the severity of the disease. However, the study lacks the good sample size and there were dropouts as well which could have been more effective in this paper. The article also mentions about the safety of this research as there are possibility of adverse effects risk, furthermore, the research lacks the significant interaction between the recovery rate and the severity. In addition to this research lacks cost benefit analysis. However, the combination therapy can be introduced with patient by the nurses and midwives in the most vigilant conditions including the follow ups.

The evidence based treatment in the area of depression is increasing day by day the fifth article focuses on a randomized control trial or RCT (Hallgren et al., 2016). This study has sample size of 945 adults along with multicenter, three group parallel randomized controlled trials. The study was conducted over the period of 3 months which was post assessment and 12 months which was taken as primary end point. The computer generated allocation was conducted externally in 36 blocs with participants in the ratio of 1:1:1. The research paper focuses on the increased effectiveness of exercise in case of severe depression. The exercise as well as the internet based cognitive therapy which resulted in a response rate of 84%. The severity of the depression reduced significantly in all three groups. The scoring was done with the help of MADRS scale which is also known as Montgomery–Åsberg Depression Rating Scale where the mean rates were 12.1 for internet based cognitive therapy and 11.4 for exercise and 9.7 for the usual care. The strength of the paper lies in the good sample size, and this clinical evidence based knowledge can be used for the further treatment and nursing. However, the process was only allocated for a shorter period of time; hence more research has to be performed on this subject. 

From the above CASP analysis, it could be confirmed that there is evidence of efficacy on physical exercise and cognitive behavioural therapy on the pattern of depression. Depression is one of the common mental disorders among the people; however, there are several patterns and severity of depression. Evidence based practice is a blooming field in case of the clinical nursing practice. The evidence practice is an important aspect of patient interaction and research. Therefore, the evidence based practice could make the nurse opt for an open minded holistic approach to assist and help the patient to overcome depression, however, from the above clinical surveys and CASP assessments it could be concluded that the physical exercise and cognitive behavioural therapy could not only relieve the depression but can also cause to maintain the emotional regulation. However, there are therapeutic interventions like c CBT which was included as technological approach did not proved as effective as the general practice and therapy. The Mindfulness based cognitive therapy has included mindfulness as an effective therapy in case of major depression. CASP assessment also included combined antidepressant medication along with the cognitive therapy which proved to be effective as well. Hence, from the CASP assessment inclusion of the physical exercise and mindfulness can be included in the nursing practice and this evidence can be further utilized with patient based approach. Though different cases have different therapeutic approach the incorporation and understanding of evidence and application can enhance the patient care and also lead a holistic approach towards nursing. 

References

Buccheri, R. K., & Sharifi, C. (2017). Critical Appraisal Tools and Reporting Guidelines for Evidence?Based Practice. Worldviews on Evidence?Based Nursing, 14(6), 463-472.

Chiesa, A., Castagner, V., Andrisano, C., Serretti, A., Mandelli, L., Porcelli, S., &Giommi, F. (2015). Mindfulness-based cognitive therapy vs. psycho-education for patients with major depression who did not achieve remission following antidepressant treatment. Psychiatry research, 226(2-3), 474-483.

Desrosiers, A., Vine, V., Klemanski, D. H., & Nolen-Hoeksema, S. (2013). Mindfulness and emotion regulation in depression and anxiety: common and distinct mechanisms of action. Depression and anxiety, 30(7), 654-61.

Gilbody, S., Littlewood, E., Hewitt, C., Brierley, G., Tharmanathan, P., Araya, R., … & Kessler, D. (2015). Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial. Bmj, 351, h5627.

Hallgren, M., Helgadóttir, B., Herring, M. P., Zeebari, Z., Lindefors, N., Kaldo, V., … &Forsell, Y. (2016). Exercise and internet-based cognitive–behavioural therapy for depression: multicentrerandomised controlled trial with 12-month follow-up. The British Journal of Psychiatry, 209(5), 414-420

Hallgren, M., Kraepelien, M., Lindefors, N., Zeebari, Z., Kaldo, V., &Forsell, Y. (2015). Physical exercise and internet-based cognitive–behavioural therapy in the treatment of depression: randomised controlled trial. The British Journal of Psychiatry, 207(3), 227-234.

Hollon, S. D., DeRubeis, R. J., Fawcett, J., Amsterdam, J. D., Shelton, R. C., Zajecka, J., … & Gallop, R. (2014). Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial. JAMA psychiatry, 71(10), 1157-1164.

Nursing and Midwifery Board of Australia. 2019. Registered Nurses Standards for practice. Available at: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/enrolled-nurse-standards-for-practice.aspx

Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas. OJIN: The Online Journal of Issues in Nursing, 18(2), 4.

World Health Organization. 2019. Nursing and midwifery. Available at: https://www.who.int/hrh/nursing_midwifery/en/