Protecting your clients in the conduct of research
Consider the topic you have selected to complete your evidence-based practice project. While we are not conducting research here, per se, we are considering implementing a new practice – and with any new practice comes the potential for both benefit and harm to clients. It’s important to think about how practice changes may affect clients – both positively and negatively. So as you get ready to conduct your EBP review, you’ll want to think about how you can make sure to keep your clients safe and your practice ethical.
In an APA format paper, approximately 3 pages in length, address the following questions. (Please note that you will continue to write in the same document you completed for part 1 of this assignment (completed in module 2) – you can keep the same cover page, correcting any errors noted on your feedback. Please correct your reference page as noted from your module 2 submission feedback and update it with your new material.) In addition, although you are submitting your entire project to date (with revisions), your actual grade will be based only on the current section, as addressed below:
Discuss what the principle of “respect for persons” means to you.
How will you ensure that it is carried out in the implementation of your EBP project? (Remember that you don’t need to know the exact outcome/findings of the project yet – you just need to consider how you will ensure autonomy for clients, and protection of those with diminished autonomy, if that is relevant to the practice setting.)
Discuss what the principle of “beneficence” means to you. How will you ensure that it is carried out in the implementation of your EBP project?
Discuss what the principle of “justice” means to you. How will you ensure that it is carried out in the implementation of your EBP project?
Consider this brief example as you begin the paper:
In previous modules, we gave this example of a PICO(T) question:
In clients over the age of 65 undergoing elective total hip arthroplasty, is chemical DVT prophylaxis more effective than mechanical DVT prophylaxis alone in preventing the development of DVT in the 30 days following surgery?
So for this assignment you might consider the following:
Respect for persons:
Do individuals have the right to refuse DVT prophylaxis if they choose (right to self-determination)?
What if they fall into the “diminished autonomy” category (i.e. have dementia, etc.)
How does this affect their right to autonomy?Beneficence:
How will this project maximize benefits and minimize harms?
What might be the benefits of changing practice or staying with the same practice?
What would be the risks?
How will you make sure that you reduce risks to clients as you consider practice changes?Justice:
How will you make sure that there is fairness in the distribution of burdens and benefits?
Will you make sure that the findings are distributed to all clients?
What about on other units? Remember, we should make sure that everyone has the opportunity to benefit from research findings, when applicable.
Running head: ADOLESCENT DEPRESSION AND ACUPUNCTURE 1
ADOLESCENT DEPRESSION AND ACUPUNCTURE 3
Adolescent Depression and Acupuncture
Christal St.Louis
Rasmussen College
NUR4232: Integration of Evidence Based Practice and Research in Nursing
Lisa Hansen
August 7, 2020
Adolescent Depression and Acupuncture
Topic Overview
Depression is a real disorder creating a global problem. The WHO identifies approximately 264 million people around the world who suffer from this disorder (Depression 1, n.d.). Major depression, also known as major depressive disorder (MDD), is defined as a single episode or recurrent episodes of unipolar depression that results in a significant change in a client’s normal functioning (Halter, 2018). For a diagnosis of major depression to be made, five or more specific clinical findings must have been present during the same 2-week period (Halter, 2018). These clinical findings are a persistent feeling of sadness or a lack of interest or pleasure in external stimuli, accompanied by depressed mood, difficulties sleeping or sleeping too much. They may experience incongruous feelings of failure and inadequacy, decreased ability to concentrate, indecisiveness, overtiredness, or suicidal ideation. Additionally, a change of more than 5% of body weight in a month or increase or decrease in motor activity can be another possible identifying symptom (Halter, 2018). For diagnosis, these symptoms must be experienced most of the day nearly every day, being the source of noteworthy and substantial deterioration in critical components of the patient’s life and be independent of any other ailments or substance abuse (Halter, 2018).
Research has shown that depression can be caused by more than just psychological factors. In fact, depression is additionally affected by biological, genetic, and environmental factors (Armour et al., 2019). Etiologically, it is believed to be the result of changes in the reception of the neurotransmitters: serotonin, norepinephrine, and dopamine (Varcarolis & Varcarolis, 2015). These changes affect numerous parts of the brain, including the hippocampus, amygdala, and limbic systems (Varcarolis & Varcarolis, 2015). While these changes have been found to have some genetic association, much research, including biochemical markers and brain scans, are still underway (Varcarolis & Varcarolis, 2015)
Discussion of patient/population of interest: Adolescents experiencing symptoms of depression
In the US the National Institute of Mental Health reports approximately An estimated 17.3 million or 7% of adults and 13.3% of adolescents who have had at least one major depressive episode with the prevalence leaning more towards females (Major Depression, n.d.). Among the adolescent population, as much as 70% of those who suffered the ordeal of a depressive episode experienced severe impairment associated with that episode (Major Depression, n.d.). It is scary to think that the youth of America are so affected by this disorder as suicide is a genuine concern for those who battle with depression. Adolescent depression is linked to substance abuse, early parenthood, higher medical expenses, and increased suicide risk (Lewandowski et al., 2013). Depression beginning before the age of 12 is further associated with increased risk for depressive episodes throughout their lifetime, reduced function, and psychiatric comorbidities (Lewandowski et al., 2013). Sadly, as of 2017, 60% of adolescents with this disorder did not receive treatment (Major Depression, n.d.). This, in part, may be due to the dependence on pediatricians, almost singularly, to detect and diagnose adolescent depression. Pediatricians may be ill-prepared and or too pressed for time to collect and adequately interpret psychiatric findings, especially in the absence of clear guidelines for the treatment of adolescent depression (Major Depression, n.d.).
Intervention of Interest
Acupuncture is an ancient and traditional form of Chinese medicine that has gained popularity and respect in the medical community. The premise that acupuncture is built on is far removed from the views of modern western medicine. According to this approach, a steady flow of energy flows throughout the body called “qi.” This energy follows specific pathways or meridians that can become blocked, resulting in ailments. Acupuncture is the insertion of small needles in specific points along meridian lines. This technique is thought to stimulate these meridians to restore the free flow of energy, bringing the body back to a state of balance and wellness. Western medicine still struggles to explain the phenomenon as these points do not seemingly correspond to any anatomical structures.
One thought is that meridian lines are instead responsive liquid collagen crystals in connective tissue that support express cellular conduction (Dossey et al., 2016). Regardless of how it works, there is considerable research conducted regarding this form of complementary therapy that has shown it to be an effective modality for a number of ailments, including depression (Dossey et al., 2016). For children and adolescents, the use of antidepressants can cause significant adverse effects, most notably an increased risk of suicide. In comparison, the most common hazards related to acupuncture include itching, bleeding, or bruising at the site (Holland, 2018). The most significant risks, such as infection, are attributed to improper technique by unskilled technicians or practitioners (Holland, 2018).
Comparative Intervention
Treating depression is very patient-specific and generally the result of trial and error. Depression is usually treated with psychotherapy and psychiatric medications (Depression 2, n.d.). In regard to adolescents, the American Academy of Pediatrics recommends simply active monitoring of mild depression. Concurrently, psychotherapy and medication are recommended for moderate to severe depression in youth (Cheung et al., 2018). They also recommend close observation for side effects and ongoing monitoring of results. Collaboration between primary care providers and mental health specialists is recommended for the co-management of those with moderate to severe symptoms, especially if they appear resistant to treatment (Cheung et al., 2018).
20112014 Surveys reported that of those 12 years of age and older, 12.7% had taken an antidepressant in the last 30 days (Antidepressant Use Among, n.d.). Antidepressants are among the most commonly used drug classes in America (Antidepressant Use Among, n.d.). 19.6% of adolescents were singularly relying on counseling or psychotherapy care by a health professional (Major Depression, n.d.). There are many types of evidence-backed psychotherapy options such as cognitive-behavioral therapy and interpersonal therapy, shown to be effective in the treatment of depression (Depression 2, n.d.). 17.9% of patients, however, are being treated with a combination approach of medicinal and psychotherapy (Major Depression, n.d.). Only 2.4 % of adolescents rely simply on medication for the treatment of their depression (Major Depression, n.d.). Antidepressants, while shown to be effective, generally take 2-4 weeks to achieve a therapeutic level and can have harmful side effects related to sleep, concentration, appetite, and sexual function (Depression 2, n.d.). In children and adolescents with depression, there is an increased risk of suicide (Depression 2, n.d.). The FDA even requires manufacturers of antidepressants to include warning labels that alert of this increased risk, additionally providing the results of pediatric studies (Suicidality in Children, n.d.). Prozac is the only antidepressant approved for the treatment of depression in pediatric patients by the FDA (Suicidality in Children, n.d.).
Outcome of Interest
A meta-analysis of 29 studies between 1980 and 2018 found acupuncture to be positively correlated to a reduction in depression severity compared to mock acupuncture application, combination treatment, and a strictly medicinal approach consisting of SSRI/SNRIs (Armour et al., 2019). The studies that compared properly applied acupuncture and mock application showed a significant difference with real application besting the competition, implying that patient reactions to acupuncture are not merely a placebo effect (Armour et al., 2019). SSRI’s, when used in conjunction with acupuncture, consistently showed greater effectiveness at reducing depression symptoms than SSRI/SNRIs when used by themselves (Armour et al., 2019). Still, more studies need to be conducted. The reality remains that approximately 30% of those treated with psychotherapy and pharmacological options will remain unresponsive to treatment on some level (Armour et al., 2019). Alternative and complementary medicine provides another avenue to help patients.
Conclusion and PICO Question
Especially in a population where medication should be the last option such as adolescents, a complementary medicine modality such as acupuncture should be considered. The National Health Interview Survey conducted in 2007 reported 12 % of children 17 and younger had used some form of CAM within the last year (Dossey et al., 2016). CAM use is becoming more widely sought out; however, when polled, 67% admitted to not having discussed CAM with any of their providers. For those who did discuss the option, only 26% of the time was the subject broached by the providers (Dossey et al., 2016). Providers need to be actively researching CAMs such as acupuncture and offering it as an opportunity to augment already provided care. When it comes to adolescent depression, the question I crafted asks Does acupuncture reduce or eradicate signs and symptoms of depression in adolescents when added to psychotherapy?
Protecting Clients
Respect for Persons
Ensuring Implementation
Beneficence
Ensuring Implementation
Justice
Ensuring Implementation
Discuss what the principle of “respect for persons” means to you.
How will you ensure that it is carried out in the implementation of your EBP project?(Remember that you don’t need to know the exact outcome/findings of the project yet – you just need to consider how you will ensure autonomy for clients, and protection of those with diminished autonomy, if that is relevant to the practice setting.)
Discuss what the principle of “beneficence” means to you.
How will you ensure that it is carried out in the implementation of your EBP project?
Discuss what the principle of “justice” means to you.
How will you ensure that it is carried out in the implementation of your EBP project?
References
Antidepressant use among persons aged 12 and over: United States, 20112014. (n.d.). Retrieved August 7, 2020, from https://www.cdc.gov/nchs/products/databriefs/db283.htm
Armour, M., Smith, C. A., Wang, L.-Q., Naidoo, D., Yang, G.-Y., MacPherson, H., Lee, M. S., & Hay, P. (2019). Acupuncture for depression: A systematic review and meta-analysis. Journal of Clinical Medicine, 8(8). https://doi.org/10.3390/jcm8081140
Cheung, A. H., Zuckerbrot, R. A., Jensen, P. S., Laraque, D., & Stein, R. EK (2018). Guidelines for adolescent depression in primary care (GLAD-PC): Part II. treatment and ongoing management. Pediatrics, 141(3). https://doi.org/10.1542/peds.2017-4082
Depression 2. (n.d.). National Institute of Mental Health. Retrieved August 7, 2020, from https://www.nimh.nih.gov/health/topics/depression/index.shtml
Depression 1. (n.d.). World Health Organization. Retrieved August 7, 2020, from https://www.who.int/news-room/fact-sheets/detail/depression
Dossey, B. M., Keegan, L., Barrere, C., Blaszko Helming, M., Shields, D. A., & Avino, K. M. (2016). Holistic nursing: A handbook for practice (7th ed.). Jones & Bartlett Learning.
Halter, M. J. (2018). Varcarolis foundations of psychiatric-mental health nursing: A clinical approach (8th ed.). [VitalSource edition]. Retrieved from https://ambassadored.vitalsource.com/#/books/9780323389679?context_token=44411cb0-763f-0136-ece1-0a580a5428bf
Holland, K. (2018, May 14). Acupuncture for depression: Does it really work? And 12 other FAQs. Retrieved August 7, 2020, from https://www.healthline.com/health/depression/acupuncture-for-depression
Lewandowski, R. E., Acri, M. C., Hoagwood, K. E., Olfson, M., Clarke, G., Gardner, W., Scholle, S. H., Byron, S., Kelleher, K., Pincus, H. A., Frank, S., & Horwitz, S. M. (2013). Evidence for the management of adolescent depression. PEDIATRICS, 132(4). https://doi.org/10.1542/peds.2013-0600
Major Depression. (n.d.). National Institute of Mental Health. Retrieved August 7, 2020, from https://www.nimh.nih.gov/health/statistics/major-depression.shtml
Suicidality in children and adolescents being treated with antidepressant medications. (n.d.). Retrieved August 7, 2020, from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/suicidality-children-and-adolescents-being-treated-antidepressant-medications
Varcarolis, E. M., & Varcarolis, E. M. (2015). Manual of psychiatric nursing care planning: Assessment guides, diagnoses, psychopharmacology (5th ed.).
