NUR 590: Evidence-Based Practice Dr. Johnsonius NUR 590 Final Paper

Section A: Organizational Culture and Readiness Assessment The assessment the learner used to ascertain her organization’s readiness for evidencebased practice (EBP) implementation was a shortened version of the OCRSIEP. The OCRSIEP was developed to help offer insights into an organization’s baseline readiness to integrate EBP into their clinical practice (Yoo et al., 2019). The learner performed the assessment on three different units of a large, inner-city teaching hospital – the emergency department, postanesthesia care unit and medical intensive care unit. Results showed barriers included lack of staff nurses who have strong EBP skills and advanced practice nurses (APNs) to mentor staff nurses. Facilitators of EBP integration included skilled librarians and a strong organizational push towards fostering EBP culture. The rationale for the high-scoring categories include the organization’s goal of applying for Magnet status within the next five years and having dedicated library staff that are wellversed in research strategies and EBP. The rationale for the low-scoring categories include lack of time and/or interest in EBP due to burnout, lack of management support in terms of dedicating time for staff nurses to perform EBP on the unit and nurses not confident in EBP research skills. Although the organization hopes to apply for Magnet status soon, nurses feel that there is not an organized effort in fostering a spirit of inquiry among the organization. A strategy the learner’s organization can adopt to help overcome these barriers and integrate clinical inquiry into the organization include establishing a mentorship program. Research shows that formalized mentorship programs between APN’s and staff nurses can help foster EBP knowledge, skills and beliefs (Spiva et al., 2017). This program should be supported by upper management, such as the chief nursing officer, and details approved by those knowledgeable in EBP principles and leadership development such as clinical nurse leaders. If 3 such a program took place in the learner’s organization, she believes that more nurses will be comfortable with performing EBP research and will foster a spirit of inquiry throughout the organization. Section B: Proposal/Problem Statement and Literature Review Traditional in-person cognitive behavioral therapy (CBT) has many barriers that lead to poor patient follow-up and thus poorer mental health outcomes. The learner’s PICO question is whether internet-based CBT (eCBT) is more effective at reducing suicidal risk in young adults, aged 18 to 25, versus traditional in-person treatment. In-person CBT is proven to be an effective and evidence-based treatment for suicide prevention (Brodsky et al., 2018) but the need for virtual solutions has increased. Not only has the Covid-19 pandemic increased this need but also in-person treatment barriers such as transport and wait times, concerns mental health stigma and cost lead to decreased follow-up appointments (Olmos-Ochoa et al., 2020). The literature review the learner performed consisted of five randomized controlled trials (RCTs) to help support the PICO question. RCTs were chosen because they are a wellestablished primary source of research. The methods they researchers used in the study established a single-blind study with control and intervention groups which ensured no bias and accurate results. In the intervention groups variations of eCBT were utilized such as a technicianassisted eCBT program (Rosso et al., 2016) and self-guided eCBT programs (Löbner et al., 2018). The control groups were offered various in-person alternatives such as treatment as usual (Rosso et al., 2016; Hetrick et al., 2017; Kladnitski et al., 2020), mental health support services (Pugh et al., 2016) or follow-ups with their primary physician (Löbner et al., 2018). The subjects of the five studies ranged from various age groups with the main similarity of scoring highly on a depression/suicidal ideation inventory. The studies included specialized 4 populations such as school-aged teens (Hetrick et al., 2017), women with post-partum depression (Pugh et al., 2016) as well as the general population aged 18 and over (Rosso et al., 2016; Löbner et al., 2018; Kladnitski et al., 2020). Unfortunately, the learner was unable to find current studies that focused on the learner’s target population of young adults aged 18 to 25. The key findings of all the studies showed that eCBT programs were able to decrease depression/suicidal ideation inventory scores more than in-person treatments. eCBT programs guided by physicians had more adherence than self-guided eCBT programs (Rosso et al., 2016) and the study of school-aged teens showed a decrease in reported suicide attempts (Hetrick et al., 2017). Secondary findings showed that eCBT helped participants overcome in-person treatment barriers such as concerns of mental health stigma (Pugh et al., 2016), cost (Rosso et al., 2016) and waiting times (Kladnitski et al., 2020). These findings support the learner’s PICO question and shows that eCBT can be an effective alternative to in-person treatment as well have the potential of being more effective for decreasing suicidal risk. Limitations that many of the studies encountered included small sample sizes (Hetrick et al., 2017; Löbner et al., 2018; Pugh et al., 2016), high dropout rates and short follow-up periods (Kladnitski et al., 2020). Further areas of studies include eCBT’s effect on suicidal outcomes, focusing on the young adult population and including more diverse social determinants of health that contribute to mental health. These limitations emphasize that future studies need to include larger, more heterogeneous populations in addition to studying the long-term effects of eCBT. Section C: Solution Description Traditional in-person cognitive behavioral therapy (CBT) has many barriers that lead to poor patient follow-up and thus poorer mental health outcomes. Barriers such as fear of mental health stigma, time and transportation constraints can be overcome with the use of internet-based 5 CBT (eCBT) (Alavi & Hirji, 2020). ECBT is a form of telepsychiatry which gives patients access to professional treatment and guidance in the comfort of their own home. This treatment modality helps to decrease missed appointments, improves access to psychiatric services and improves continuity of care by (Jacobs et al., 2019). Telepsychiatry has been researched for the past couple decades but has been propelled into practice due to the social distancing requirements from the ongoing Covid-19 pandemic. Including eCBT in the learner’s organization’s telehealth repertoire would be a big change for the psychiatric department but is would not be unrealistic or costly since a telehealth framework has already been established. Currently the learner’s organization offers many different in-person psychiatric treatment, including CBT, but no mention of eCBT as part of their services (NYP.org, n.d.-a).