Evidence based practice on depression - Essay Example

Running head: evidence based practice on depression Evidence based practice on depression of article: Family Focused Grief Therapy: A Randomized, Controlled Trial in Palliative Care and Bereavement 2. Method used to locate article: Web searched using the keywords depression, therapy, evidence, method, result, and grievance. Article available with full view access on authentic websites was selected. 3. Method used to conduct study: The research conducted by Kissane et al. (2006) uses family relationships index on 257 families of patients dying from cancer, categorized into well-functioning, intermediate and dysfunctional classes based on cohesiveness, openness and courage to deal with conflicts. The dysfunctional families exhibited least of these characters, indicating high rates of psychosocial and clinical depression. About 15-20% of these families were dysfunctional and slightly higher in the initial stages of palliative care. The intermediate families also exhibited moderate chances of psychosocial morbidity. Family members of these two groups were included in the assessment of family relationship index. Different assessment methods were used to assess the three main indicators of family relationships-cohesiveness, conflict, and expressiveness (of thought and feeling). The Family Assessment Device based on the McMaster Model, The Brief Symptom Inventory based on Hopkins Symptoms Checklist, Beck Depression Inventory, The Social Adjustment Scale, The Bereavement Phenomenology Questionnaire were used to collect data to assess the three indicators of family relationships from a sample of 257 families comprising 701 individuals. 4. Description and purpose of study: Example: Why did they do the treatment? This article aimed to assess and reduce depression among family members of patients diagnosed with terminal illness such as cancer. Purpose of the study was to minimize risks of depression among caregivers and family members. High-risk families identified through family-relationship index that contained patients with at least 6 months prognosis and between age 35 and 70 years were included in the study. Other inclusion criteria included ability to understand English, living with partner, having children older than 12 years and geographical accessibility. This data was obtained from cancer institutes and hospice-care services, and individual written consent was obtained from every participant including the patients. Measurement of relationship index was done at 6 and 13 months post prognosis. First stage of measurement included assessment by an individual researcher of issues and concerns relevant to specific family. Next was the intervention therapy by well-qualified therapists focusing on agreed concerns; this part was accomplished through two to four sessions. Finally, control or termination process consisting of standard palliative care including clinical and psychosocial counseling was performed. 5. Result of study: Example: Result of the treatment study (outcome) Measures obtained from various tests summed up to a 51% of families in the intermediate functioning range and 49% as dysfunctional. The intervention and control sessions were conducted on all selected families; some families withdrew from intervention sessions due to feelings of intrusion. Significant number of families did not participate in the assessments measures. Overall depression assessment from 6 through 13 months indicated substantial reduction of grief among families receiving family focused grief therapy. However, this varied within the type of families. The intermediate families showed substantial improvement while in the intervention phase than in control phase. The dysfunctional families showed varying responses, with some responding positively to the grief therapy while others deteriorated further. This research focused on reducing or preventing pathological grief caused to the family members than overall and normal grief. Furthermore, this research focuses on assessing short-term or immediate grief, and not on the chronic grief that may follow after loss of family member. 6. How does this study relate to a psychiatric unit? Coping with grief caused due to loss of loved one to a fatal illness like cancer is a very complex and sensitive process, and depends upon intensity of illness at various stages, people’s prior experiences with and exposure to handling such situations, their religious, cultural, and social beliefs, mental strength, support from others etc. The thought of impending loss of loved one causes depression and distress related to mental, physical, social or emotional aspects. Mental reactions can include anger, guilt, anxiety, sadness, or despair; physical reactions like sleeping problems, change in appetite, health issues can occur. Disturbances in social aspects may be in the form of taking over other family responsibilities, interacting with family and friends, ability to return to work etc. These symptoms need to be identified in order to help the members cope with distress and depression caused thereby. Hence, Kissane et al.’s (2006) research focused on a family-focused grief therapy that can help family members cope with the grief. 7. Can the findings be implemented easily: If the finding of #3 can be implemented easier. How would you do this? Although the focus of this research seems simple and straight, its methodology and structure are highly complex, requiring expert knowledge, ample time and great efforts for appropriate interpretation and implementation of the results. It also requires many qualified psychiatric personnel for conducting the grief therapy sessions, administering questionnaires, conducting interviews, and other interventions. A psychiatric unit is usually well equipped with trained and qualified personnel who can conduct the required sessions of therapy and counseling. However, this kind of study may not be applicable in a psychiatric unit as the unit comprises of different kinds of patients, not limited to terminally ill patients. In such cases, the personnel would require specific training to deal with this category of patients and their family members. Also, the methodology in this study is very extensive and periodic, which makes its implementation in a psychiatric unit highly complicated in terms of periodic accessibility to the same sample population. 8. How would you implement the easier procedure in a psychiatric unit. A simpler procedure to provide psychotherapy to family members of terminally ill patients in a psychiatric unit would require a different approach. Coping with fatal illness for the patient is extremely important; and this, to a large extent, will help in providing the other family members with required mental and emotional strength to accept the reality. Coping mechanisms in the form of psychotherapy, counseling sessions along with family involvement can be included as a part of cancer therapy. 9. What are the risks to implementing the change in practice? Psychotherapy of patients along with treatment of the illness may or may not have the desired impact on family members. As direct focus on family members is minimal, chances of misinterpretations of family members’ reactions as well as therapists’ interactions are potentially high. 10. Since you are changing the procedure. How would you plan to deal with the Risk of Change. Risks of misinterpretations can be avoided by ensuring periodic psychotherapy sessions for the patients accompanied by family members. The therapist has to strive towards establishing a personal dialogue with the family members. The therapist has to take into account different factors that affect family members’ psychology, such as age, gender, cultural and social background, behavior and attitude, external support mechanisms, financial situation etc. 11. What information do you on the unit need to implement the change in practice Eample: Manuel (text)..Lecture..etc.. Patient’s demographic information, type of illness, and an assessment of depression may be required. In addition to this, demographic information of family members, their cultural and social background, financial status and responsibilities are essential for psychotherapists to incorporate therapy along with treatment. 12. Would the staff on your psychiatric unit agree to implement the change ?Why or why not? The psychiatric unit staff will agree to implement this change provided they receive ample training in handling terminally ill patients. The training should focus on aspects such as different types of coping mechanisms meant for terminally ill patients, data collection and interpretations skills, knowledge of cultural aspects that influence human behavior, 13. What team members are important to implementing the change? Such as Head nurse, Physician..etc..etc.. Implementation of this procedure requires involvement of the a well-trained and qualified psychotherapist, the treating physician, all attending nurses and other hospital personnel. Reason for active involvement of all these people may be attributed to the sensitivity of the issue; each person associated with the treatment and therapy can make a significant impact on the patient and his/her family members by providing adequate support, appropriate guidance and required treatment/therapy; establishing a healthy relationship with the patient and family members. 14. How would you know the change had been implemented… Implementation of this change and its effectiveness may be assessed through observation of patient’s behavior; family members’ attitude and behavior towards different situations throughout the therapeutic period; and by establishing a personal connect with the psychotherapist and the patients’ families. Reference Kissane, D. W et al. (2006). Family Focused Grief Therapy: A Randomized, Controlled Trial in Palliative Care and Bereavement. American Journal of Psychiatry, 163: 1208 – 1218. http://ajp.psychiatryonline.org/cgi/content/full/163/7/1208 Read More