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Transitioning from Traditional-based Practice to Evidence-based Practice in Psychiatric NursingJohanna AllisonUniversity of CincinnatiJune 3, 2016AbstractThis literature review compiles and synthesizes six research studies published between the years 2014 through 2016. All of these research studies can be found in peer-review nursing journals. The studies examine the application of nursing strategies and how they can enhance mental health care and psychiatric nursing practice. The results suggest the need for more research to be done in the mental health field in order to build evidence for transforming nursing practice. IntroductionIn the past, people suffering from mental illness received maltreatment due to a dehumanizing stigma within society. Fortunately, today the stigma is being reduced by people and programs advocating for mental health awareness, and mental illness is taken more seriously by the public and by the government. Programs such as Medicare, Medicaid, and Social Security Disability Insurance improve access to mental health care and often provide financial aid to patients suffering from mental illness (Shelton, 2015). A lot of psychiatric nurse practice still relies heavily on tradition rather than scientific data. Researchers are now interested in shifting mental health care practice from being mostly traditional-based to entirely evidence-based to ensure the safest and most effective care. This literature review will examine intervention studies about possible evidence-based strategies in psychiatric nursing practice. Intervention studies evaluate the application of nursing strategies in order to enhance health care or prevent complications (Zauszniewski, Suresky, Bekhet, & Kidd, 2007). BackgroundPsychiatric nursing practice has had its roots in traditional-based practice since the beginning of time (Forchuk, 2001). Traditional-based practice often relies on old wisdom, old textbooks, and old theories. Traditional-based practice usually has no scientific evidence or data backing it up. They are usually a result of trial-and-error or random application methods that have worked for others in the past (Zauszniewski et al., 2007). Evidence-based practice is the incorporation of the current best evidence into decision-making for patient care. Evidence-based practice improves care procedures and patient outcomes by relying on the most reliable scientific knowledge rather than custom (Shelton, 2015). The future of psychiatric nursing depends on the development of evidence-based practice (Zauszniewski et al., 2007). MethodsIn order to advocate for the implementation of evidence-based practice into psychiatric nursing, this literary review will examine research studies published in peer-reviewed nursing journals from 2014 to 2016. The research articles are free and available to read in these popular nursing journals: The Online Journal of Issues in Nursing, The Journal of Psychiatric and Mental Health Nursing, A Scholarly Journal of the American Nurses Association, and Issues in Mental Health Nursing. The main demographic of these peer-reviewed journals are practicing psychiatric nurses, who are in the best position to apply this research knowledge into practice. These research studies will be used to show the type of research being disseminated to current psychiatric nurses. ResultsResearch Settings and Targeted PopulationsAmong the six research articles selected, five of them were conducted in the United States and one was conducted in Japan. Four studies took place in an institution, such as a hospital, and two studies took place in a community setting, such as the patient’s home. The studies targeted adolescents, adults, elderly people, or a combination of these demographics. One selected study targeted adolescents, three targeted adults, one targeted elders, and one targeted a combination of these age groups. Each study included those who are mentally ill with depression, bipolar disorder, dementia, schizophrenia, or a combination of these illnesses. None of the selected studies included people who are without mental illness.Interventions in the Biologic Domain“Biological interventions focus on physical functioning and are directed toward the patient’s self-care, activities and exercise, sleep, nutrition, relaxation, hydration, thermoregulation, and finally, pain and medication management” (Zauszniewski et al., 2007). Among the six research articles selected, four fall into the biologic domain. Four example, a study conducted by Carter, Morres, Repper, and Callaghan (2016) examines the experiences of twenty-six adolescents with depression who participated in their preferred exercise program. The adolescents were then interviewed. The adolescents’ experiences feelings of improved mood, achievement, and enjoyment that could help alleviate their depression (Carter et al., 2016). In another study conducted by Crowe, Beaglehole, and Inder (2016) studies how the use of sleep/light manipulation could promote mood stability within bipolar patients. Sleep/light interventions include dark therapy, sleep deprivation, bright light therapy with the goal to regulate circadian rhythms, specifically the sleep-wake cycle. Interventions in the Psychological Domain“The psychological domain includes counseling, conflict resolution, bibliotherapy, reminiscence, behavior therapy, cognitive interventions, psycho-education, health teaching and spiritual interventions” (Zauszniewski et al., 2007). For example, a quasi-experiemtnal study conducted by Matsuda and Kohno (2016) explained how psycho-education programs for patients with schizophrenia have been shown to improve medication adherence, the patient’s awareness of symptoms from their illness, the patient’s coping skills, and reduces the frequency of relapse. The psycho-education programs reduced the amount of patients with schizophrenia that had to be rehospitalized. Interventions in the Social Domain“The social domain can be viewed as including the patient’s environment and its effect on the patient’s reactions to disorders and stress…Interventions in the social domain include milieu therapy, safety, home visits, group, family, and community actions” (Zauszniewski et al., 2007). For example, in a study conducted by Jha, Seavy, Young, and Bonner (2015) explained how people with dementia often live in their home, and are supported by unpaid caregivers, such as family members and friends. The study shows how these caregivers lack the resources and skills to properly take on the challenges of treating a patient with dementia, and it shows how community care and registered nurse home visits could improve the care a dementia patient receives. Combinations of DomainsOne of the studies selected use a combination of the aforementioned domains. One study conducted by Alderman, Olson, Brush, and Shors (2016) combined the biologic domain and the psychological domain by having people participate in mental and physical (MAP) training to see if it could reduce depression. The mental training included meditation, which falls into the psychological domain, and the physical training- or aerobic exercise- falls into the biologic domain. The study had fifty-two participants complete an eight-week intervention. The participants were then interviewed and individuals with major depressive disorder reported less depressive symptoms. Changes in Nursing PracticeThe transition from traditional-based practice to evidence-based practice within psychiatric nursing will best ensure the highest quality of health care to patients. This transition will be the most important topic for future mental health nurses (Zauszniewski et al., 2007). More research should be conducted in order to build evidence for nursing practice. This transition will change nursing education, research, and practice. For example, one research article by Bolster, Holliday, Oneal, and Shaw (2015) discovered that many nurses do not receive any sort of training to help treat patients with suicidal tendencies. Nurses are in the best position to identify suicidal tendencies and prevent a suicide attempt because they come in contact with the patient the most out of all other health professionals. Nursing education, however, does not include a training program to treat suicidal patients. Bolster et al. (2015) said that training programs should change nurses’ attitudes about suicide and improve their detection skills. The implementation of a suicide prevention training programs could change nursing education and improve health care by preventing suicides and treating suicidal patients. ConclusionScientific research will be implemented into psychiatric nursing practice in the future. It has the potential to change mental health care for the better. Quality health care is dependent on the practice patients receive, and researchers have proved that evidence-based practice is the most effective method. ReferencesAlderman, B., Olson, R., Brush C., and Shors, T. (2016). MAP training: Combining meditation and aerobic exercise reduces depression and rumination while enhancing synchronized brain activity. Translational Psychiatry, 6(2), 726-.Bolster, C., Holliday, C., Oneal, G., Shaw, M. (2015). Suicide assessment and nurses: What does the evidence show? OJIN: The Online Journal of Issues in Nursing, 20(1).Carter, T., Morres, I., Repper, J., & Callaghan, P. (2016). Exercise for adolescents with depression: Valued aspects and perceived change. Journal of Psychiatric and Mental Health Nursing, 23(1), 37-44.Crow, M., Beaglehole B., & Inder M. (2016). Social rhythm interventions for bipolar disorder: A systematic review and rationale for practice. Journal of Psychiatric and Mental Health Nursing, 23(1), 3-11.Forchuk, C. (2001). Evidence-based psychiatric/mental health nursing. Evidence-Based Mental Health, 4(2), 39-40.Jha, B., Seavy J., Young, D., & Bonner, A. (2015). Positive mental health outcomes in individuals with dementia: The essential role of cultural competence. OJIN: The Online Jounral of Issues in Nursing, 20(1).Matsuda, M., & Kohno, A. (2016). Effects of the nursing psychoeducation program on the acceptance of medication and condition-specific knowledge of patients with schizophrenia. Archives of Psychiatric Nursing, 1-6.Shelton, D. (2015.) Overview and summary: Emotional health: Strategies for nurses. OJIN: The Online Journal of Issues in Nursing, 20(1).Zauszniewski, J., Suresky J., Bekhet, A., Kidd, L. (2007). Moving from tradition to evidence: A review of psychiatric nursing intervention studies. The Online Journal of Issues in Nursing, 12(2). ................
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