Nursing researchers over the years have developed a rigorous, systematic, and formal system of inquiry which nurses use in producing and checking out theories concerning the stories of humans' fitness of their environments (Fawcett & Garity, 2008). C-T-E refers to conceptual model guiding the nursing research, middle range theory which the nurses are looking for to generate or to check and the empirical fashions that the nurse makes use of in accomplishing the research (Burns, Grove, & Gray, 2011).The research may be in the form of theory testing research. This research will be in the form of theory testing which will be designed to teat a middle range theory in the nursing practice.A theory in this context is defined as one or more specific concepts or relatively concepts which a researcher derives from a conceptual model (Fawcett & Desanto-Madeya, 2013). Theory, therefore, is a proposition that describes the concepts and the proposition narrowly stated relatively concrete and specific concepts (Fawcett & Garity, 2009).This paper focuses on depression as a clinical condition to be studied.
The research will use the concept of depression among adult patients as a guide.Clinical depression is a mood disorder which affects one’s ability to handle daily activities. Depression is characterized by low mood that persists for a long time (National Institute of Mental Health (US), Hirschfeld, & Lobel, 1985). Depression is a painful experience, and it is quite common for older adults. Some people have experienced phases of depression at least once in their lifetime and have passed them without severely affecting their lives.However, others have been severely affected by depression. The symptoms of depression include the experience of depressed moods, losing interest in the previously enjoyed activities, self-criticism and guilt, pessimism, hopelessness, memory difficulties, difficulty in concentrating, changes in sleeping patterns, changes in appetite and weight and often thought of committing suicide (Moussavi et al., 2007). The research will use deductive reasoning in developing an evidence-based research. Thus, the paper structure will proceed from conceptual to practical indicators, to the theory.The research will use Sister Calista Roy’s Adaptation theory in undertaking the evidence-based study.
The concept is depression and can be defined in a variety of ways. The definition, however, seem to revolve around a general empirical concept that describes depression as a mental condition from which the victims show long-term mood disorders or feelings of sadness which can then lead to a permanent loss of interest. Dorland medical dictionary defines depression as desperation, sadness, or melancholy; mental disorder accompanied by one too many depressive episodes. The medical science dictionary, however, defines depression as the drop in a mood which brings about a clinically discernible state and a decrease in levels of functionality.As explained by the American Psychiatric Association and the World Health Organization, depression is simply the existence of symptomatology that is a clinical disorder, which negatively impacts a large percentage of the population at a given point in their lives; this state can be prolonged or transitory. Depression is a multifactorial disorder united by affective symptoms, such as low mood, discouragement, and sadness, and cognitive symptoms, such as low self-esteem, and hopelessness (Hammash et al., 2013).
The conceptual model of nursing practice includes diagnostic operations which refer to the identification of the service unit practice and the reason why nursing is needed (Majid et al., 2011). It also includes the collection of demographic data and determination of present and future demands of therapeutic self-care. The second component of the conceptual model is the prescription operation which refers to the specification of the means to be used in meeting the therapeutic self-care demand. The design and implementation of nursing system and methods known as the regulatory operations also constitute conceptual models. The regulatory operations include the design of nursing system performance operation which is the nursing care plan (Parahoo, 2017).
Evidence-based practice will be used in seeking information regarding depression symptoms in the patients on an inpatient psychiatry unit. The cause and symptoms of depression may vary from one individual to another. Depression is one of the global contributors to disease burden, and it affects all the people around the world (WHO, 2012). Therefore, hospitals treat depression with all the seriousness that it deserves. Evidence-based research is therefore needed for the clinician to develop effective treatment procedure and at the same time reduce readmission rates that would arise if the disease is not treated properly. The patient will be questioned using the PHQ-9 scale. The evidence will then be used by the clinician to develop treatment methods and strategies to enhance quality patient outcome.
The theory that the research will employ is The Sister Calista Roy’s Adaptation theory. This theory was developed by Calista Roy during her graduate program at University of California and was published in 1970 (Roy & Andrews, 1999). According to Roy, human beings are a holistic adaptive system when constantly interacting with external and internal factors (Roy, 2002).The theory assumes that a person is a bio-psycho-social being. Therefore, there exists a constant interaction between a person and the environment, either internal or external environment (Lutjens, 1991). For one to cope up with the constant state of changing the environment, there is a need to use both the innate qualities as well as acquired mechanisms which constitute biological, social or psychological in origin (Roy, 2008). Another assumption states that for a person to positively respond to the changes in the environment, a person must adapt. There exist four modes of adaptation according to Roy, these are self-concept, role function, inter-dependence and physiologic needs.
The major concepts in Roy’s theory include adaptation which is the goal of nursing, the person provided as the adaptive system, environment or the stimuli, health which is the outcome of the adaptation and lastly nursing which is the act of promoting the adaptation and health (Fawcett, 2002). The aging population is slowly increasing in number, and this age bracket faces problems of adaptation to life changes including a decline in physical activities. The concepts of the theory, therefore, comes into play for an evidence-based research. This theory will, therefore, facilitate application of consistent theoretical basis for the treatment of depressed old people (Parahoo, 2017). The adaptation concept is relevant to the evidence-based research since it gives a basis for the research (Rogers & Keller, 2009). The severity of the effects of depression can be attributed to the ability of the patient to adapt to the environment. Whenever a patient cannot adapt to the surrounding during depression phase, undertaking daily activities becomes difficult.The theory will, therefore, be used in embracing change among these individuals.
Sister Calista Roy’s Adaptation Theory is useful in differentiating between the aspects of care which are unique to the nursing profession and assessment of depression in particular and the medical practice as a whole within the context of Roy’s four modes of adaptation (Meleis, 2011).The theory provides for the indicators of adaptation including positive and negative indicators. While treating depression, adaptation is a fundamental component of the positive response to the treatment (Parker, 1993). This theory help nurses to be able to understand another person’s behavior and response to the medications using the four concepts (Kim, 2000). The main objective of nursing as a profession is the forward movement of a person’s personality including behaviors and physical activities. Therefore, with the adaptation concept, in theory, nurses would be able to determine whether there is an improvement of a person’s personality or not. Each nursing practice includes a range of activities, including orientation to resolution (Roy & Roy Adaptation Association, 2014).
The PHQ-9 contains nine items all of which asses the DSM-IV major depression disorder criteria. The 9-item criteria make it easy to use the DSM-IV major depression diagnostic algorithm. Respondents rate their symptoms on a 4-point Likert scale which show the rates by which the patients are dosturbed by the symptom in the past two weeks. The scale starts from 0 for not at all, 1 for several days, 2 for more than half the days, and 4 for nearly every day. It takes 2 minutes to complete.The PHQ-9 is useful in the conducting research. The questions are documented in a questionnaire which is administered to the patient. This is a reliable way for seeking evidence from a patient. The patient will need the fill in the questionnaires within a matter of minutes. From the answers given by the patient, the nurse can determine the extent of depression and mental problem that the patient undergoes. From the questionnaire, the nurse can determine the symptoms that have manifested in the patient. Since the questions are administered in a question form, this method is reliable. The theory will also be helpful while measuring the response of the patient towards medication (Ahtisham, & Sommer, 2015). The method has a good test reliability, sensitivity to change, and consistency.
Patient Health Questionnaire (PHQ-9) contains 9 items all of which asses the DSM-IV major depression disorder criteria. The 9-item criteria make it easy to use the DSM-IV major depression diagnostic algorithm. Respondents rate their symptoms on a 4-point Likert scale which show the frequency of bother from the symptom in the past two weeks. The scale starts from 0 for not at all, 1 for several days, 2 for more than half the days, and 4 for nearly every day. PHQ-9 takes 2 minutes to complete.Corresponds more closely with the criteria for major depressive disorders as illustrated with DSM-IV. The total scores on the scale range from 0 to 27; with 0-4 for no depression, 5-9 mild depression, 10-14 for moderate depression, 15-19 for moderately severe depression, and 20-27 for severe depression. The item has high construct validity that shows 88% for both specificity and sensitivity.
Evidence-Based Practice Change Model
Evidence-Based Practice (EPP) change model is a problem-solving approach that integrates the most effective and efficient clinicians’ expertise, patients’ values and preferences, and available scientific evidence. However, to implement the EBP model, the Advancing Research and Clinical Practice (ARCC) model must be brought into play. The ARCC model was developed as part of strategic planning plan. The major aim of the ARCC model was to establish an enhanced integration of clinical and research practices in community healthcare and acute-care settings, both nationally and locally (Fineout-Overholt, Levin & Melnyk, 2004). Several major factors were, however, identified to influence the ability to base practices on evidence. A successful implementation of the ARCC model entails, an inquiry is a component of the daily practice, overall goals and focus towards quality outcomes, a process in place for a purposeful achievement of best outcome, ensuring a clear outcome and process data.CBT helps in shaping the clinician’s individual behavior towards Evidence-Based Practice. The thoughts and beliefs of ARCC model are influenced by environment, social and individual factors. One of the steps that can be employed to form an EBP process using ARCC includes cultivating the attitude for inquiry followed by asking burning questions in PICOT format. Without a properly formulated and focused set of questions, the method may become difficult and time consuming when identifying suitable evidence and relevant evidence to help solve the depression cases. The PICOT stages include; P for the population of interest, I for intervention, C for comparison group or intervention, O for the outcome, and T for the time frame. The PICOT questions can thus be formulated using the PHQ-9 questions to help curb the depression instances.
The population of Interest (P). The level requires one to think of the demographics of the patients, or probably the type of depression problem they are experiencing. For instance, the depression problem could the loss of interest in activities once enjoyed. The issues may also vary depending on locality, age, and gender, and should also consider questions related to ethnicity, demographic variables, or socio-economic status. Moreover, the stage may also entail identifying the severity and duration of the depression problem.
Intervention (I). This stage entails questions that seek to establish the type of intervention under consideration. For instance, which type of medication is under consideration; does it involve rest, drugs, or exercises. The intervention would thus be a medication or a preventive measure. As in depression, for an individual faced with lack of interest in activities once enjoyed, the intervention would be a change in lifestyle. The PHQ-9 questions could thus be aimed at establishing the intensity of how frequent they would want to be involved in such future activities, and if they don’t, establish other similar activities that might be interesting to them.
The Comparison Group (C). This PICOT level entails questions that seek to establish the availability of an alternative treatment. For instance, the comparison could concern another form of medication, a distinct type of treatment like rest, or probably no treatment at all. Moreover, it may also entail patients’ admission without depression diagnosis on the medical unit.
Outcome (O). The O level involves questions about the desired result, the effects not wanted, or probably the likelihood or existence any side effects attached to the form of treatment or testing. As in the depression case, loss of interest, the most desired outcome would be that the patient regains interest and participate again in the activities initially enjoyed. The measures of success, an, in this case, include happiness and frequency of participation in such activities. The success of the strategy would then assist in reducing cases of depression and lower rates of hospitalization among depressed patients. When these are achieved, it massively reduces morbidity, time, cost, and mortality rates.
Timeframe (T). This is the stage and involves establishing or mentioning the duration taken by the whole process. The PICOT process is most effective if it reduces the amount of time taken for the entire process. This is because it not just aimed at reducing the frequency of inpatient admissions, but also reducing the number of resources being used in treatment and medication. When the timeframe is reduced, the process can then be implemented.
The PICOT stages will be preceded by searching for and collecting the most relevant best evidence and critically appraising them. The researcher will then integrate the best evidence with their own clinical expertise and patient preferences or values in making a practical decision or change. The researcher will then evaluate outcomes of the practice decision or change model. The last step will be disseminating the outcome of the EBP decision or change. However, the identified barriers will be mitigated or removed from both the individual or healthcare settings. The researcher will strengthen the cognitive beliefs about the value of EBP.
Researchers in the field of nursing involves a rigorous, systematic and formal process of inquiry which nurses use in generating and testing theories concerning the experiences related to people’s health. In this paper, Sister Calista Roy’s theory of adaptation was used to guide research in depression among the aging population. The research will comprise an identification of the problem, reviewing of the selected literature, adaptation to the local setting, assessment of barriers and then monitoring and evaluation of outcome. The significance of the theory is that it provides a framework for measuring the progress of the research. The theory has four components which are the adaptation, environment, health, and nursing. The research will use PHQ-9 in asking questions to help in determining symptoms and the extent of those symptoms in depression persons. The PICOT will guide questions. The questionnaire will be filled by the patients in a matter of minutes and then scored by the nurse. The evidence change model used in the project is the Advancing Research and Clinical practice through close Collaboration (ARCC) Model.