Evidence Based Practice Proposal paper
Organizational Culture and Readiness Assessment
Organizational culture involves the beliefs, interactions and values among the members to achieve a common goal. Mental health facility culture entails the beliefs and expectations of health care providers to ensure multidisciplinary approach is applied in patient care (Williams et al., 2015). Through the survey, it was concluded that the mental facility was accustomed to using pharmacotherapy in the management of depression among confined patients. 80% of the staff understood the importance of the project and had a positive attitude towards it.
This is because they had knowledge on the cited positive outcomes of the therapy. Only 25 % of the staff were confident on their ability to provide interpersonal psychotherapy, 75% of the staff claimed to lack skills. 35% of the staff reported to be informed on the current trends in psychiatry because they attended several trainings on the same. All the health care providers were however ready to embrace interpersonal psychotherapy as a way of managing the patients.
Some of the identified barriers included lack of knowledge and skills among the healthcare workers, lack of adequate resources, and lack of adequate evidence on the benefits of new therapy and ambivalence. As compared to pharmacotherapy, IPT not only manages depression but also discover the triggers. Through IPT one is able to establish trustworthy relationship with the patient hence leading to holistic care. In order to ensure successful implementation of IPT, training programs, conducting more research and amendment of organization policies to favor the implementation of the intervention are essential.
Evidence based practice problem statement
According to WHO 2018, depression is among the leading morbidity in the world cutting across all ages. Currently the prevalence is at 75% of the population, within 10 years the prevalence of depression increased by approximately 18%. NIMH states that 6.7% of the population in the United States suffer from active symptoms of feeling worthless, diminished interest, sadness, lack of appetite and insomnia. In the point of criminal offence, those who were found to be mentally unstable were to be admitted to mental facility. It was however reported that a higher percentage of mentally ill patients were in captivity rather than in mental institutions (Treatment advocacy Center, 2014). The female gender has high incidence of depression than male and incarceration increases the risk by 50%.
Pharmacotherapy, Cognitive behavioral therapy and Interpersonal Psychotherapy (IPT) are commonly used to manage depression (Felton et al., 2019). IPT is a time-bound and evidence based approach used to manage acute depression by developing interpersonal relationships and social interaction (Johnson et al., 2019). It explains that personal relationships and psychological problems are integrated. According to National Institutes of Health, IPT on its own can be as effective as the antidepressants and is adequate for patients who cannot tolerate medication. It focuses on addressing the relationship patterns that trigger the symptoms rather than managing the symptoms (Rothberg, 2017). IPT does not just relieve depressive symptoms but also improves social interactions and skills of an individual.
Study subjects
Participants included a group of 50 men that were randomly selected from the prison who met the criteria for current MDD in reference to DSM-V classification. Simple random sampling method was used to select inmates who consented and presented with severe symptoms of depression and not just acute episodes. Inmates suffering from Bipolar mood disorder, phobias or anxiety disorders were excluded.
Methods
Controlled randomized trial was used to conduct the survey. It involved a period of 2 months in-prison preparation then 10 weeks of IPT followed by 4 months post-release therapy (Breedvelt et al., 2018). Half of the subjects were treated as the control experiment and provided with similar hours of therapy entailing non-IPT procedures. Started with group sessions lasting atmost 90 minutes relative to their reported concentration span. The experimental group focused on relationship patterns and other interpersonal deficits. The control group discussed on treatment compliance, effects of MDD and other treatment options apart from IPT.
Key findings
80% of the experimental group showed high adaptability to the society after the survey. Less than 10% depressive episodes were reported from the experimental group as most of them portrayed social interaction and positive interpersonal relations. 20% 0f the participants reported suicidal attempts and ideation among other depressive symptoms. All the other inmates showed interest in the IPT therapy. Subjects undergoing IPT therapy were found to require low or no doses of antidepressants as they had recovered from interpersonal traumas.
Limitations
The study faced the following limitations
- Small sample size compared to the population worldwide. Therefore, the research findings cannot be used to represent general population including non-prisoned.
- Inadequate time. I strained to create time amid the busy schedule to find time specially to collect data and analyse.
Conclusion
Major depressive disorder is mental illness that presents with depressed mood, displeasure in daily activities, sleep disturbances, lethargy and pessimistic thoughts. Depression leads to deficit in the interpersonal relations like social isolation and is not always triggered by a relationship or event. IPT aims to improve quality of interpersonal relations and social interactions. IPT is the most effective method of managing MDD compared to other forms of treatment since it not only relieves symptoms but also mends social interaction and skills.
Breedvelt, J. J. F., Kandola, A., Kousoulis, A. A., Brouwer, M. E., Karyotaki, E., Bockting, C. L. H., & Cuijpers, P. (2018). What are the effects of preventative interventions on major depressive disorder (MDD) in young adults? A systematic review and meta-analysis of randomized controlled trials. Journal of affective disorders, 239, 18-29.
Felton, J. W., Hailemariam, M., Richie, F., Reddy, M. K., Edukere, S., Zlotnick, C., & Johnson, J. E. (2019). Preliminary efficacy and mediators of interpersonal psychotherapy for reducing posttraumatic stress symptoms in an incarcerated population. Psychotherapy Research, 1-12.
Johnson, J. E., Stout, R. L., Miller, T. R., Zlotnick, C., Cerbo, L. A., Andrade, J. T., … & Wiltsey-Stirman, S. (2019). Randomized cost-effectiveness trial of group interpersonal psychotherapy (IPT) for prisoners with major depression. Journal of consulting and clinical psychology.
Rothberg, B. (2017). Group Interpersonal Therapy (IPT) for Depression.
Williams, B., Perillo, S., & Brown, T. (2015). What are the factors of organizational culture in health care settings that act as barriers to the implementation of evidence-based practice? A scoping review. Nurse education today, 35(2), e34-e41.
