Scientific Underpinnings of the DNP Project

Scientific Support

Do you have research evidence to support that your selected intervention is an effective approach to your selected practice problem? If not, you need to change your selected intervention; you intervention must be based on current research evidence. You must have at least 10 primary references, either primary research studies or systematic reviews, to support your selected intervention as an approach to the practice problem. Note the evidence you use must be contemporary in nature and be no more than 5 years old. The only dated evidence that can be used would be seminal works such as theories, models, etc.

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Review, revise, and refine your evidence tables. Use the evidence tables in the APA template for your project proposal located in DocSharing. You may also use the evidence tables from your NR701 course. Notice that there are two evidence tables; one is for primary research and one is for systematic reviews. Reviews of the literature, integrative reviews, state of the science papers, or clinical summary articles should not be on these tables since they are secondary sources. However, use these to find primary research articles to read and review and possible use as evidence.

Evidence Review

  • Write a review of the 10 contemporary research studies you found relating to your project and its intervention.
  • Each research study should have its own paragraph and include:
    • Identify researcher(s) and date of publication
    • Primary purpose of the study
    • Research methodology and design used
    • Identify who subjects/participants were
    • How data was collected (via surveys, questionnaires, observation, etc.)
    • Type of data analyses conducted and major/significant findings
    • Discussion of how the study and its findings/conclusions relate to your proposed project

Evidence Synthesis

Does the evidence answer your PICOT question? Write a synthesis of the evidence related to your practice problem and your selected intervention. A synthesis is not an article by article summary but rather an integration. Address similarities, differences of opinions inherent in the Evidence Review.

Practice Recommendation

Based on your synthesis of the evidence, what practice change would you recommend? Ensure the Practice Recommendation clearly supports your intervention(s). What does the evidence indicate as effective approaches to the practice problem? Describe your practice recommendation derived from your evidence synthesis. Discuss how this recommendation has led you to select the intervention in your PICOT question.

Theoretical Framework

What is the theoretical framework for your DNP scholarly project? Describe a theory or model to serve as the foundation of your project. How will your selected theory/model guide you within the context of your project? What are its major assumptions and how do they relate to the various stages of your project (needs assessment, planning, intervention/implementation, evaluation, etc.)?

In addition to nursing theories, consider theories from other disciplines (i.e., behavioral, social sciences, education) or organizational theories that are optimally appropriate for your DNP scholarly project. The following are theoretical foundations you may find helpful:

  • Nursing theory (Watson, Neuman, Leininger, Benner, etc.) OR Theory borrowed from other disciplines –
    • Theories from Social Sciences: Social Exchange Theory, General Systems Theory, Feminist Theory.
    • Theories from Behavioral Sciences: Human Needs Theory (Maslow’s Hierarchy of Needs), Health Belief Model Theory of Planned Behavior.
    • Theories from Biomedical Sciences: Germ Theory and Principles of Infection, Stress and Adaptation: General Adaptation Syndrome, Pain Management: Gate Control Theory.
    • Complexity Science Theories: Complex Adaptive Systems Theory.
    • Learning Theories: Social Cognitive Theory.

Put your answers below and copy and paste this portion into the collaborative thread for week 3

PICOT: In community clinic nursing staff, how does the introduction of standard guidelines within ten weeks affects the accuracy and quality of diagnosing depression in the older population as compared to the staff’s performance before the intervention?

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Scientific Support

The project considers the implementation of the evidence-based and evidence-supported depression screening and management guidelines developed by the National Institute for Health and Care Excellence [NICE] (2016) of the UK.

Evidence Review

The following review considers the evidence that supports various aspects of the NICE (2016) guidelines, including the cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), psychodynamic interventions, psychological interventions, and stepped care, which makes the following sources relevant to the project.

To review the effectiveness of CBT in depression management, Tovote et al. (2014) conducted a randomized controlled trial (RCT) with 94 diabetes patients with depression, using questionnaires and statistical analysis. The results indicated that CBT significantly reduces depression symptoms in the population.

To review culturally-appropriate CBT, Naeem et al. (2015) conducted an RCT with 280 Pakistani patients, using the Hospital Anxiety and Depression-Depression Subscale for data collection and analysis. The results show that culturally-appropriate CBT is helpful in reducing depressive symptoms.

Hollon et al. (2014) compared the use of CBT combined with pharmacotherapy to the use of only pharmacotherapy in depression recovery. Their RCT with 452 patients used the Hamilton Rating Scale for Depression and statistical analysis and showed that CBT enhances the recovery process.

Driessen et al. (2013) examined the effectiveness of CBT and psychodynamic therapies in an RCT with 341 adults, using the Hamilton Depression Rating Scale and statistical analysis. No difference was found between the interventions, and both were shown to be effective.

Lemmens et al. (2015) compared CBT and IPT in an RCT with 182 depressed adults, using the Beck Depression Inventory and statistical analysis. Both CBT and IPT were found equally effective.

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Donker et al. (2013) compared Internet-based CBT and IPT in an RCT with over 1200 participants, using the Center for Epidemiological Studies Depression scale and statistical analysis. Both interventions were shown to be effective, although CBT presented better results.

Jiang et al. (2014) show the effectiveness of IPT in depression treatment with the help of an RCT with 38 earthquake survivors, using the Structured Clinical Interview for DSM-IV for MDD diagnosis and statistical analysis.

Cuijpers, Donker, Weissman, Ravitz, and Cristea (2016) review the effectiveness of IPT in treating mental disorders with the help of a systematic review and meta-analysis of 90 high-quality studies, finding that IPT is helpful for depression treatment.

Patel et al. (2017) review a form of psychological treatment for severe depression with the help of an RCT with almost 500 patients, using the Beck Depression Inventory and statistical analysis. The results show that the intervention combined with usual care is more effective than usual care.

In a triangulated systematic review and meta-analysis of fourteen high-quality studies, Straten, Hill, Richards, and Cuijpers (2015) show that stepped care tends to have a positive effect on depression management, although more research is needed on the topic.

Evidence Synthesis

No recent articles appear to test the NICE (2016) guidelines, but their elements are supported by high-quality recent evidence; some inconsistent results also suggest that certain interventions (CBP) may be more effective than other options (IPT). Thus, the evidence appears to suggest an affirmative answer to the PICOT question.

Practice Recommendation

The practice recommendation for the VEGA center would be to adopt a form of guidelines that promote the use of evidence-based depression screening and management, and the suggested intervention (NICE (2016) guidelines) corresponds to these requirements, which is why it was chosen.

Theoretical Framework

A theoretical framework that should help the project is the Iowa Model of Evidence-Based Practice (IMEBP). IMEBP is a well-established model that guides the process of translating evidence and guidelines to practice (White & Spruce, 2015). As summarized by White and Spruce (2015), the model’s assumptions include starting the process with organizational needs assessment and evidence analysis, which should be followed by several implementation steps, an evaluation of change, and its maintenance. Thus, IMEBP can guide every element of the project from needs assessment to evaluation. Other models can be used to enhance the process; for instance, Rogers’ Innovation Diffusion Theory would help during the implementation (Hanrahan et al., 2015), but IMEBP is the theoretical core of the project.

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Cuijpers, P., Donker, T., Weissman, M. M., Ravitz, P., & Cristea, I. A. (2016). Interpersonal psychotherapy for mental health problems: A comprehensive meta-analysis. American Journal of Psychiatry, 173(7), 680-687.

Donker, T., Bennett, K., Bennett, A., Mackinnon, A., van Straten, A., Cuijpers, P.,… Griffiths, K. M. (2013). Internet-delivered interpersonal psychotherapy versus internet-delivered cognitive behavioral therapy for adults with depressive symptoms: Randomized controlled noninferiority trial. Journal of Medical Internet Research, 15(5), 1-33.

Driessen, E., Van, H. L., Don, F. J., Peen, J., Kool, S., Westra, D.,… Dekker, J. J. (2013). The efficacy of cognitive-behavioral therapy and psychodynamic therapy in the outpatient treatment of major depression: A randomized clinical trial. American Journal of Psychiatry, 170(9), 1041-1050.

Hanrahan, K., Wagner, M., Matthews, G., Stewart, S., Dawson, C., Greiner, J., &… Williamson, A. (2015). Sacred cow gone to pasture: A systematic evaluation and integration of evidence-based practice. Worldviews on Evidence-Based Nursing, 12(1), 3-11.

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.

Jiang, R. F., Tong, H. Q., Delucchi, K. L., Neylan, T. C., Shi, Q., & Meffert, S. M. (2014). Interpersonal psychotherapy versus treatment as usual for PTSD and depression among Sichuan earthquake survivors: A randomized clinical trial. Conflict and Health, 8(1), 14-24.

Lemmens, L. H. J. M., Arntz, A., Peeters, F. P. M. L., Hollon, S. D., Roefs, A., & Huibers, M. J. H. (2015). Clinical effectiveness of cognitive therapy v. interpersonal psychotherapy for depression: Results of a randomized controlled trial. Psychological Medicine, 45(10), 2095-2110.

Naeem, F., Gul, M., Irfan, M., Munshi, T., Asif, A., Rashid, S.,… Farooq, S. (2015). Brief culturally adapted CBT (CaCBT) for depression: A randomized controlled trial from Pakistan. Journal of Affective Disorders, 177, 101-107.

National Institute for Health and Care Excellence. (2016). Depression in adults: Recognition and management. Web.

Patel, V., Weobong, B., Weiss, H. A., Anand, A., Bhat, B., Katti, B.,… Vijayakumar, L. (2017). The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: A randomised controlled trial. The Lancet, 389(10065), 176-185.

Straten, A., Hill, J., Richards, D. A., & Cuijpers, P. (2015). Stepped care treatment delivery for depression: A systematic review and meta-analysis. Psychological Medicine, 45(2), 231-246.

Tovote, K. A., Fleer, J., Snippe, E., Peeters, A. C., Emmelkamp, P. M., Sanderman, R.,… Schroevers, M. J. (2014). Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: Results of a randomized controlled trial. Diabetes Care, 37(9), 2427-2434.

White, S., & Spruce, L. (2015). Perioperative nursing leaders implement clinical practice guidelines using the Iowa Model of Evidence-Based Practice. AORN Journal, 102(1), 50-59.

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