C-T-E Structure and EBP Model Assignment

C-T-E Structure and EBP Model Assignment
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C-T-E Structure and EBP Model Assignment
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
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
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.
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
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
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
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
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.
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
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
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
being from 64-.81 in depression (Persoon’s et al, 2003). PHQ-2 also shows stable test-retest
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
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.
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.
Fawcett, J., &Garity, J. (2008). Evaluating research for evidence-based nursing practice. FA
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): 206220, 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):10231032.
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): 316323. ISSN 0163-8343.doi:10.1016/s0163-
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). Evidencebased 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
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-

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