The Doctorally Prepared Nurse Scholarship

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West Coast University *

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Nursing

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Nov 24, 2024

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1 Locating and Critically Analyzing Primary Research Articles

2 Locating and Critically Analyzing Primary Research Articles In nursing practice, various health issues require nursing intervention. The DNP-prepared nurses have a significant role to engage in scholarship activities to inform practice that solves specific and identified nursing issues. In this paper, the focus is on a high level of depression among older adults. Depression is one of the challenging mental illnesses among the adult population. Based on experience and clinical encounters with the patient in the workplace, there are higher rates of depression among older people than younger people. Depression is one of the most common geriatric psychiatric disorders and a major risk factor for disability and mortality in older patients. Depression is a common mental health problem in the elderly population, yet it has remained undiagnosed in about 50% of cases (Zenebe et al., 2021). WHO estimated that the global depressive disorder among older adults ranged between 10 and 20%. Among all mentally ill individuals, 40% were diagnosed to have a depressive disorder (Zenebe et al., 2021). People with depressive disorder have a 40% greater chance of premature death than their counterparts. Depression harms the quality of life as it impacts both the psychological and social domains of quality of life (Vinay & Edward, 2019). This assignment focuses on interventions to reduce depression among older people as the topic of interest to analyze and synthesize the peer- reviewed research to inform advanced nursing practice. The assignment includes the key steps taken to locate the primary and peer-reviewed research articles when performing a literature search on this topic. The assignment also describes the resources that are available to engage in a meaningful and successful literature search. Literature Search Strategy A literature search is a critical component for any evidence-based project. In this assignment, there were at least five steps used in the search strategy. The first step was to

3 develop clinical questions based on the PICOT format. The clinical question was “among older adults diagnosed with depression, what is the effectiveness of using cognitive behavioral therapy compared with treatment as usual?”. The second step was to make a list of relevant databases that would be used for the search. These databases included Pubmed, CINAHL, Embase, Cochrane Library, and Scopus. The third step was to develop keywords and phrases relevant to the topic. These keywords included cognitive behavioral therapy, CBT, depression, evidence- based practices, older adults, and effectiveness. The fourth step was to search the identified pertinent databases. The process started by searching broadly using a few keywords and then adding more words after seeing the scope of the literature. The initial search did not produce many results and therefore, the need to play with removing some keywords and adding more granular detail. I also used Boolean search with AND and OR. For instance, old adult AND depression, cognitive behavioral therapy OR old adult with depression. The fifth step was to filter the search to include publication years between 2015 and 2022, English language, and peer review articles. The final step was to select relevant articles. Summary of the Articles The final search results produced 26 relevant articles. However, the summary of the article focuses on three main articles. In the first article, Sadler et al. (2018) conducted a randomized controlled clinical trial. The aim of the study was to determine the effectiveness of cognitive behavior therapy in treating older adults presenting symptoms of depression and insomnia. The study setting was community mental health unit. The participants of the study included people aged 65 years old and above. The interventions included an advanced form of cognitive behavior therapy and a standard form of cognitive behavior therapy. Outcome measures were pre-treatment during the start of the week, post-treatment which included eight

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4 weeks, and finally, 3-month follow-up. The result of the study proved the effectiveness of both CBT-I and CBT-I+ in minimizing the severity of insomnia and symptoms depression among the older adults (Sadler et al., 2018) The second article is based on a multicentre, randomized, observer-blinded, active- controlled, parallel-group trial to determine the efficacy of using session individually-delivered CBT in reducing self-reported symptoms of depression compared to a supportive unspecific intervention (SUI) under the same number of sessions and same duration (Dafsari et al., 2019). The study included 248 participants diagnosed with moderate to severe depression as defined by ICD-10 aged 60 years and above. The interventions include Late-life depression (LLD) specific cognitive behavioral therapy (LLD-CBT) for the experimental group and supportive unspecific intervention for the control group. The results of the study showed that LLD-CBT is superior to SUI when used with patients diagnosed with late-life depression in reducing the symptoms of depression (Dafsari et al., 2019). The third article examines evidence-based Cognitive behavioral therapy (CBT) in treating depression (Gautam et al. 2020). By using various pieces of literature including a meta-analysis of 115 studies, Gautam et al. (2020) found that cognitive behavioral therapy (CBT) is effective in reducing symptoms of depression. When combined with pharmacotherapy, Gautam et al. (2020) assert that CBT is effective in treating depression compared to using pharmacotherapy alone. Synthesis of the Three Articles using a Scholarly Voice Based on selected articles, it is evidenced that depressive disorders are some of the prevalence mental health challenges, especially in old adult. Depression is one of the leading causes of mental disability globally. While depression is common in all populations, older adults are at high risk of depression because of reduced quality of life, the closeness of death, functional

5 impairment, loneliness, and financial restrains. Depression disorder can cause other medical conditions in older people. Such medical conditions include diabetes mellitus, risk of suicide, high blood pressure and cardiovascular disease. Depression also causes a socioeconomic burden. However, interventions such as CBT have been confirmed effective in managing and treating depression symptoms. Both the three articles confirmed that. Cognitive behavioral therapy can be used to reduce symptoms associated with depression when used alone or in combination with medications. In treating depressive symptoms, CBT is used to modify the beliefs that maintain depression. CBT is also used to address different psychosocial problems associated with depression. The Differences between Summarizing and Synthesizing Research In scholarly writing, summarizing and synthesizing research are two distinct activities. In summary, the key points from individual sources are shared in each paragraph while in synthesis, one needs to combine the information from several or multiple sources and add a personal analysis of the literature. It implies that synthesizing research entails each paragraph having multiple sources, citations, and the waiter’s ideas and voice. The goal of the summary is to provide the key ideas while the goal of synthesis is to create an understanding of the information from several texts. An example of a summary is when asked to give the main points from a single research article on the application of CBT with people diagnosed with depression. On the other hand, an example of synthesis is providing in insight from several research articles on CBT and its application in depression management. Conclusion Overall, a literature search is an important scholarly activity that DNP-prepared nurses can use to inform a particular practice. In this assignment, it was identified that depression in an

6 old adult is a significant issue of concern. The literature search revealed that cognitive behavioral therapy (CBT) is one of the widely used evidence-based psychological interventions for treating depression. The three articles selected confirmed that CBT is effective in reducing symptoms of depression and modifying the beliefs that maintain. Therefore, CBT can be used as the standard intervention for depression across healthcare settings.

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7 References Dafsari, F. S., Ramirez, A., Jessen, F., Dafsari, F. S., Bewernick, B., Wagner, M., Biewer, M., ... Jessen, F. (2019). Cognitive behavioral therapy for the treatment of late-life depression: Study protocol of a multicentre, randomized, observer-blinded, controlled trial (CBTlate). Bmc Psychiatry, 19, 1. https://doi.org/10.1186/s12888-019-2412-0 . Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (January 01, 2020). Cognitive Behavioral Therapy for Depression. Indian Journal of Psychiatry, 62, 8, 223 . doi:10.4103/psychiatry.IndianJPsychiatry_772_19. Sadler, P., McLaren, S., Klein, B., Harvey, J., & Jenkins, M. (2018). Cognitive behavior therapy for older adults with insomnia and depression: a randomized controlled trial in community mental health services. Sleep New York Then Westchester-, 41, 8. https://doi.org/10.1093/sleep/zsy104 . Vinay, K. C., & Edward, T. C. (2019). Prevalence of depressive symptoms among older adults who reported medical cost as a barrier to seeking health care: findings from a nationally representative sample. BMC Geriatrics, 19, 1, 1. Zenebe, Y., Akele, B., W/Selassie, M., & Necho, M. (2021). Prevalence and determinants of depression among old age: a systematic review and meta-analysis. Annals of General Psychiatry, 20, 1, 55.

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