Evidence-based practice in psychiatric care: defining levels of evidence

Ethics in nursing: A systematic review of the framework of evidence perspective

Aim:

To determine the current state of knowledge on nursing and ethics and to assess the knowledge and experience based on the evidence in this regard.

Background:

Although ethics is at the center of the nursing profession and the ethical issues affecting nurses are given much importance, few studies have focused on professional ethics in nursing. In this respect, ethics has become a concept that contains controversial and ambiguous situations.

Design:

The Preferred Reporting Items for Systematic Reviews and Meta-analyses guide, a basic search algorithm, was taken.

Data sources:

Cochrane, PubMed, CINAHL Complete, PsycINFO, and ULAKBIM from 2012 to 2016.

Review methods:

Following a systematic search strategy, all papers were assessed in relation to inclusion criteria and type of study. When sufficient information was not available in the title and summary of the works, the necessary data were evaluated in full texts.

Results:

This review was completed with 27 articles meeting the research criteria. The evaluation identified six themes: (1) ethics and nursing, (2) ethical difficulties/ethical dilemmas and nursing, (3) ethical competence and nursing, (4) professional ethics and nursing, (5) ethics, education, and nursing, and (6) ethics in health research.

Conclusion:

As a result of the review, a synthesis of high evidence-level research relating to nursing ethics was obtained. The emphasis was on the importance of further research and education so that the ethical aspects of nursing can be better understood throughout the studies. Nursing researchers’ level of evidence on ethics and their orientation to high research design will shed light on uncertain and controversial aspects of the subject.

Ethical consideration:

Since this was a systematic review, no ethical approval was required. There is no conflict of interest in this literature review.

Comprehensive care and pregnancy: the unmet care needs of pregnant women with a history of rape

This paper proposes a framework for assessing the unmet needs of rape survivors during pregnancy based on the Sexual Assault Nurse Examiner (SANE) practice level theory and an empirical exploration of rape survivors' health status in pregnancy via a secondary analysis. Our findings indicate that there may be unmet needs in pregnancy related to all five post-assault comprehensive care components: (1) physical care, (2) pregnancy prevention, (3) sexually transmitted infection screening, (4) psychological care, and (5) legal care. Rape history and its current impact on the survivor predicted somatic disorders, substance use, unwanted pregnancy, infections, posttraumatic stress disorder, and recent abuse.

Think Effectively About Mood Swings (TEAMS): a case series of cognitive-behavioural therapy for bipolar disorders

BACKGROUND AND OBJECTIVES

An integrative cognitive model for bipolar disorder proposes that multiple and extreme appraisals of changes in internal state and their reciprocal impact on behaviour, physiology and the environment provide the core mechanism in maintaining and escalating bipolar symptoms (Mansell, Morrison, Reid, Lowens, & Tai, 2007a).

METHODS

A case series of cognitive-behavioural therapy (CBT) based on this model, known as the TEAMS approach (Think Effectively About Mood Swings), with seven participants was conducted. An A-B direct replication design with multiple baseline and follow-up assessments at one, three and six months was used. Treatment involved 12 sessions of CBT with an emphasis on addressing extreme positive and negative appraisals of internal state change.

RESULTS

Improvements were reported for symptoms, functioning, cognitions and self-critical processes with large effect sizes on a range of measures, especially depression, at end of therapy and one-month follow-up. Five participants also showed clinically significant change in depression at both time-points.

CONCLUSIONS

This study provides preliminary evidence for the feasibility, acceptability and efficacy of CBT based on this model which warrants further evaluation.

Evidence-based practice principles: using the highest level when evidence is limited

Clinicians providing psychiatric care are often faced with selecting interventions in areas of care for which there is limited scientific support, such as the information on traumatic stress responses and integrated care interventions. If they adhere to the principles of evidence-based practice (EBP), the lack of scientific support should not hamper clinicians from implementing the best EBP intervention. EBP interventions can be drawn from the literature provided clinicians accurately appraise the level of existing scientific knowledge. Regardless of the level of evidence, clinicians must discuss the recommended intervention, risks, benefits, and alternatives to achieve the best EBP outcome.

Evidence-based practice and research scholars programs: Supporting excellence in psychiatric nursing

Delivery of quality psychiatric nursing care depends, to a certain extent, on nurses' ability to apply sound evidence to practice. Much of the needed evidence is in the form of research. The term evidence-based practice (EBP) is used to describe the application of research and other forms of clinically relevant information to practice. This article provides a historical context for EBP and describes two programs at The Menninger Clinic that support nurses on their journey to excellence and directly impact the quality of nursing care delivered at Menninger. The Evidence-based Practice Scholars Program and the Research Scholars Program are mission critical initiatives at the hospital. The Evidence-based Practice Scholars Program has led to the implementation of EBP policies and guidelines. The first project of the Research Scholars Program has been launched. The results of the program have the potential to improve the quality of nursing care as the current study will inform nurses about patients' perceptions of good nursing care and how these perceptions correspond with professional standards and scope of practice. Whether nurses are interested in being consumers of research or involved in the conduct of research, programs such as these help create a research-minded culture, much needed in contemporary health care arenas. These programs have the potential to transform nursing practice, improve the quality of nursing care, and enhance nursing job satisfaction. These are essential elements needed to sustain an environment that fosters excellence. In an era where patients and providers demand the application of research to health care, organizations must respond by investing in programs to promote excellence in this regard.

Evidence-based practice: critical appraisal of qualitative evidence

One of the key steps of evidence-based practice is to critically appraise evidence to best answer a clinical question. Mental health clinicians need to understand the importance of qualitative evidence to their practice, including levels of qualitative evidence, qualitative inquiry methods, and criteria used to appraise qualitative evidence to determine how implementing the best qualitative evidence into their practice will influence mental health outcomes. The goal of qualitative research is to develop a complete understanding of reality as it is perceived by the individual and to uncover the truths that exist. These important aspects of mental health require clinicians to engage this evidence.

Effect size in psychiatric evidence-based practice care

Developing evidence-based practice skills requires a familiarity with the language and terminology of clinical research. Few articles discuss concepts, such as effect size, that must be understood to determine if the findings of studies are clinically meaningful. Clinically meaningful results of studies are determined by the effect size of an intervention. The effect size of an intervention, such as cognitive-behavioral therapy, can be calculated from the findings of different studies using different designs and populations. However, the determination and use of an effect size is important to clinicians using research findings to guide practice.