C-T-E Structure And EBP Model Assignment

Running head: C-T-E STRUCTURE AND EBP MODEL 1

C-T-E Structure and EBP Model Assignment

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C-T-E Structure and EBP Model Assignment

Introduction

The C-T-E structure for this project will be as follows: Depression (C) - Cognitive

Behavioral Theory (T) - PHQ-2 (E). E-C-T structure refers to a system that is governed by

knowledge or expertise of nursing. It requires a high nursing level that encompasses

interpersonal skills, creative and critical thinking abilities, and psychomotor skills. This system

promotes stability in the nursing operation and for that matter should be ethically embraced by

every nursing practitioner. A nursing practitioner should use this system for data interpretation

and determination of necessary interventions necessary to implement change. Through the model

and theories, this structure provides a nursing knowledge system that is applicable to nursing

practice and research. Advanced-practice nursing professionals need to understand the linkages

in the nursing sector and then incorporate them into the nursing practice. Development of the

nursing knowledge requires the nurses design a structure to test theory. This structure is

important to the researcher as a doctoral prepared nurse because it forms the three components of

research. The conceptual model or the concept seeks to guide the research, the theory is

something that can be tested while the empirical research methods are the ones used to conduct

the research. Fawcett (2009) defines nursing research as a formal, systematic and rigorous

process involving inquiry so as to generate and test theories that are related to health experiences

of human beings. The CTE structure makes this possible because it breaks down the areas of

research.

The Evidence Based Practice Model (EBT) chosen for the project is Behavioral System

model theory. This model was developed by Dorothy E. Johnson and mainly advocates for

effective and efficient handling of patients to prevent any instance of illness. It also puts more

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emphasis on a research-based knowledge as relates to the effects of nursing provision to patients

(Fawcett & Garity, 2008). According to this theory, nursing is described as an external

regulatory intervention, which operates with the objective of preserving the organization and

integrating the behavior of patients within an optimum level. It is based on the principles that

nursing should work towards improving the welfare of the society.

According to this theory, nursing has four goals including helping patients whose

characters are proportional to the demands of the society, and assisting those who are in a

position to modify their behaviors towards supporting biological imperatives. Others include

helping patients who are in a position to benefit from the skills of the physician during treatment,

and helping patients whose behaviors have no evidence of unnecessary trauma caused by illness

(Fawcett &Garity, 2008). Therefore, since the project is about depression, which affects an

individual’s mental health, the Behavioral System model Theory will have a significant role

while elaborating the concept.

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Concept/ Conceptual Framework

It is necessary for healthcare providers to possess an astute understanding of the various

concepts applicable in the field of nursing. Concept refers to integrated mental formulation of

world perceptions. In this respect, they can be used to provide guidance to the clinical practice of

healthcare providers, which is vital for the interaction of patients and other people. The concept

for this project is depression. PICOT refers to a format that summarizes the research questions to

be explored by the project. It is an abbreviation for Population (P), Intervention (I), Comparison

(C), Outcome (O), and Time (T). This project seeks to examine how active duty or retired

military members benefit from the effective use of PHQ-2 Depression Screening as opposed to

those not screened. This means that the population in the study is the retired military members

while the intervention is the use of PHQ-2 Depression Screening. On the other hand, the

comparison/ control is the population not subjected to PHQ-2 Depression Screening while the

outcome refers to the number or percentage of individuals confirmed to be suffering from

depression. Healthcare professionals normally witness good treatment results and are motivated

to conduct research to examine their anecdotal experiences (Fawcett &Garity, 2008). The need to

gather new knowledge and experiences both within their profession and outside to promote the

healthcare system is very important. The most important step for a researcher is to interact with

other experienced researchers to share their knowledge and experience about the study.

Major depressive disorder, also known simply as depression, is a mental disorder

characterized by at least two weeks of low mood that is present across most situations. It is often

accompanied by low self-esteem, loss of interest in normally enjoyable activities, low energy,

and pain without a clear cause. Depression is a relatively common psychiatric disorder, which

can be found in people of all ages. Reddy (2010) argues that by the year 2020, depression is

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estimated to be the second in the ranking of Disability Adjusted Life Years for people of all ages.

Most of the time, primary care providers are given the responsibility to treat many of the people

suffering from depression and not necessarily mental health professionals. Depression has been

discovered to be a very serious condition. WHO has characterized depression to be among the

most disabling disorders globally as it affects a fifth of women and a tenth of men at one time

during their lifetime(Fawcett &Garity, 2008). Approximately 21 percent of women and 12

percent of men in America have gone through a period of depression during their lifetime. It

does not discriminate people based on gender, age, social status, or educational background.

Also, every area of life is likely to suffer when depression strikes as it affects friendships,

marriages, careers, and so on. When depression occurs, there is a high likelihood that it will

recur.

When combined with other diseases such as stroke and diabetes, or with other disorders

such as substance abuse, the effects of depression can be very detrimental. The problems that

escalate depression are often worsened because people suffering from depression are often

neither diagnosed nor treated (Fawcett &Garity, 2008). However, if depression is identified and

treated in time, its effects can effectively be managed. It can be treated in its early stages when

the symptoms are not yet severe. Despite being proved to be a brain disorder, its exact causes

have always remained debatable. A range of factors can be attributed to be the cause of this

disorder, such as changes in hormonal state, genetic characteristics, substance abuse, diseases,

stress, and so on. This disorder affects people’s thoughts, behaviors, and emotions. Some of the

common symptoms include sadness, hopelessness, guilt, agitation, and moodiness. People may

also occasionally have false beliefs, see, or hear things that others cannot (Fawcett &Garity,

2008). Some people have periods of depression separated by years in which they are normal

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while others nearly always have symptoms present. Major depressive disorder can negatively

affect a person's personal, work, or school life, as well as sleeping, eating habits, and general

health (Reddy, 2010). It is believed that as many as 60 percent of people who lose their lives by

suicide had depression during their lifetime. For this reason for healthcare professionals to

diagnose this disorder, its symptoms are expected to have been in existence for a period of at

least two weeks or even more.

Often, military soldiers are stigmatized because they are thought to be tough. Those in the

military also go out to war and they are expected to survive regardless of harsh conditions. When

the soldiers return, they are at risk of suicidal attempts because of trauma and also because they

are unable to speak up. This is regardless of there being multiple mental health interventions in

today’s society. The soldiers (Both active and retired) suppress a lot of issues due to the stigma

and shame involved in seeking help. Studies have shown that depression and symptoms of

depression are prevalent in the soldiers who have sustained brain injury. In fact, up to 31.8% of

veterans who have been diagnosed with brain injury are known to suffer from major depression

(Tanielian & Jaycox, 2008). Another study done by Hoge et al. (2006) shows that 22.9% of army

infantry soldiers that had been deployed to Iraq and returned home for up to at least three to four

months were diagnosed with major depression.

Depression, previously known as melancholia, was first experienced in the second

millennium B.C. During this period, individual suffering from mental illnesses were thought to

be demons possessed and treated by priests. The first historical understanding of depression was

that depression was a spiritual or mental illness rather than a physical one. Other communities

that considered mental illness to be caused by demons include Chinese, and Egyptian. In this

context, affected individuals could only be treated through exorcism, a practice that involved

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whipping, restraint, and starvation. In contrast, early Roman and Greek doctors thought that

depression was both a biological and psychological disease.

Hippocrates, stated, personality traits and mental illnesses were related to balanced or

imbalanced body fluids called humours, classifying mental illnesses into categories that included

mania, melancholia (depression), and phrenitis (brain fever). According to Hippocrates,

melancholia could only occur when an individual has excessive black bile in his/her spleen. He

considereda process called bloodletting, exercise, and dieting as the most appropriate ways to

treat depression.

Theory

The Cognitive Behavior Theory focuses on the problem and is “action-oriented”. This

means that it is an effective way to treat specific problems like depression. The therapy assists

the patient in coming up with and practicing strategies that decrease the symptoms of the mental

disorder. The PICO stipulated that the goal was to decrease the suicide rate by 50% amongst

those patients screened for depression. This is entirely possible because the Behavioral System

Model Theory combines both the behavioral and cognitive psychology to achieve positive

results.

Behavioral System Model Theory is grounded on the notion that people’s thought

distortions and poor adaptive behaviors have a huge role to play in the development and in the

maintenance of psychological disorders (Field, Beeson & Jones, 2015). Cognitive Behavioral

Theory (CBT) has been found to be very effective in the treatment of depression, anxiety, and

substance abuse among others.

The population for this study; active, retired military officers are known to suppress their

mental health issues, and this could be detrimental to their overall wellbeing. CBT focuses on

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how they think the way they act and the way they interact. According to this theory, a person’s

thoughts play a huge role in determining the way that person feels and the way they behave.

After the screening is carried out using the PHQ-2 and a person is diagnosed with depression, the

intervention will be this therapy based on the Cognitive Behavior Theory. The healthcare

professional can use CBT to make the veteran more aware of his or her behavioral patterns that

result from distorted thinking. CBT will help the people to develop alternative ways to think and

to behave. The veterans who could be suffering from major depression are able to control their

thinking and the resulting actions, which will lead to the outcome stipulated in the PICO to

reduce the number of suicides by 50%.

Empirical Indicator

The PHQ-2 is a tool that is administered to the patient in the form of a questionnaire. The

purpose of this tool is to screen for depression as the first step. The scores in the questionnaire

range from 0 to 6. If a patient scores three or more, he or she is required to be further evaluated

using tools such as the PHQ-9 to establish the final diagnosis. This screening method is brief and

it assesses if there is presence of a depressed mood or if the patient has lost interest in routine

activities. This tool is effective for the researcher’s population because it has good diagnostic

sensitivity (Whooley et al., 1997). This means that it will allow the military officers to feel at

ease without necessarily having them get out of character, as the society requires of them.

This evaluation tool reliability is excellent as has been determined through multiple

conveniences, the use of random samples and research studies (Lowe, 2004). Therefore, the tool

indicates internal consistency with the Cronbach’s alpha being at 0.88 when measuring

depression (Lowe, 2004). Consequently, the Inter-rater reliability is good with the Kappa’s range

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being from 64-.81 in depression (Persoon’s et al, 2003). PHQ-2 also shows stable test-retest

reliability.

The PHQ-2 has content validity in the sense that it covers DSM-IV criteria for mental

disorders like major depressive disorders, bulimia and even anxiety. The validity of the PHQ is

also consistent with the PRIME-MD and the AUCs range from .89 to .92 in the detection of

depression (Lowe, 2004). It should also be noted that the tool is convenient because the patient

completes it independently and it can be used to assess multiple health concerns.

Evidence Based Practice Change Model

Evidence Based Practice (EBP) is actually meant to improve the quality of care provided

to the patient and control the costs of healthcare. The EBP model for this project is the Iowa

model that promotes quality care. The first step in this model is the trigger, which could be either

problem-focused or knowledge-focused. Most often, problem focused triggers in health care are

clinical problems or even issues to do with risk management. Knowledge triggers on the other

hand could entail new research findings in a particular field (Schaffer et al., 2013).

After the issue has been identified, it is made a priority to the organization after which

relevant review of literature is carried out. When enough evidence has been gathered, a change in

practice is made and the outcomes monitored. The EBP change model impacts the entire

organization and the organizational culture (Fawcett &Garity, 2008). It needs to involve

everyone in the organization from the lowest ranks to the highest. A good example of this in

context to the PICO question and the depression concept is how new guidelines relating to the

concept can be referred to as knowledge triggers. Most of the time people suffering from

depression go undiagnosed and untreated and this translates to higher rates of morbidity to

individuals (Fawcett &Garity, 2008). Therefore, a healthcare facility will focus on these new

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guidelines related to depression, and provide necessary healthcare resources to be used by the

patients with depression. The knowledge trigger will ultimately highlight the need for change in

the system. However, for change to take place research has to be carried out and literature

reviewed together with the population that the facility serves.

Summary

The C-T-E structure for this project was as follows: Depression (C) - Cognitive

Behavioral Theory (T) - PHQ-2 (E). The theory chosen for the project was Cognitive Behavior

Theory. The PHQ-2 is a tool that is administered to the patient in the form of a questionnaire.

The purpose of this tool is to screen for depression as the first step. The EBP tool for the

assignment was the Iowa Model. Ace Star Model can be used to integrate evidence into practice.

It comprises of five core stages that include discovery of knowledge, summary of evidence,

practice attributions, practice application, and then conducting evaluation. It is among the most

utilized frameworks, which have grounded evidence-based healthcare system. It is a good model

for understanding and analyzing cycles and nature of knowledge that are applicable in various

incidences of evidence-based practice. The model makes use of both new and old ideas to

improve healthcare since it is an integration of relationships within a range of knowledge

transformations. Its importance is based on the idea that it puts more emphasis on the unique

provisions of Evidence Based Practice. In this respect, it acts as an examiner and organizer of

how EBP is applicable.

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References

Fawcett, J., &Garity, J. (2008). Evaluating research for evidence-based nursing practice. FA

Davis.

Field, T. A., Beeson, E. T., &Jones, L. K. (2015). The new ABCs: A practitioner's guide to

neuroscience-informed cognitive-behavior therapy.Journal of Mental Health Counseling,

37 (3): 206–220, doi:10.17744/1040-2861-37.3.206

Hoge, C. W., Auchterlonie, J. L., &Milliken, C. S. (2006). Mental health problems, use of mental

health services, and attrition from military service after returning from deployment to

Iraq or Afghanistan. JAMA. 2006; 295(9):1023–1032.

Persoons, P., Luyckx, K., Desloovere, C., Vandenberghe, J., & Fischler, B. (2003). Anxiety and

mood disorders in otorhinolaryngology outpatients presenting with dizziness: Validation

of the self-administered PRIME-MD patient health questionnaire and epidemiology.

General Hospital Psychiatry. 25 (5): 316–323. ISSN 0163-8343.doi:10.1016/s0163-

8343(03)00072-0

Reddy, M. S. (2010). Depression: The disorder and the burden. Indian journal of psychological

medicine, 32(1), 1.

Schaffer, M. A., Sandau, K. E., &Diedrick, L. (2013). Evidence‐based practice models for

organizational change: Overview and practical applications. Journal of Advanced

Nursing, 69(5), 1197-1209.

Tanielian. T., &Jaycox, L. H. (2008). Invisible wounds of war: Psychological and Cognitive

Injuries,Their Consequences and Services to Assist Recovery. Santa Monica, CA: RAND

Corporation; 2008

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Whooley, M. A, Avins, A. L, Miranda, J., &Browner, W. S. (1997). Case-finding instruments for

depression: Two questions are as good as many. Journal of General Internal Medicine.

12 (7): 439–45. PMC 1497134 Freely accessible.PMID 9229283. doi:10.1046/j.1525-

1497.1997.00076.x.

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