Evidence-Based Practice Section A and B: Organizational Readiness and Problem Statement (Cognitive Behavioral Therapy vs. Selective Serotonin Reuptake Inhibitors or SSRIs)
The implementation of any change initiative in an organization depends on the readiness of that organization in accepting and embracing the change. An organization is not the buildings. It is the people who work in it. Therefore, organizational readiness refers to the willingness of the employees to accept change. In organizations that have employees who are complacent and in a comfort zone, it may be very difficult to achieve success with any change project since they will sabotage all change efforts. This is why it is important to evaluate the readiness of any organization intending to implement change before going all out with the project. Various tools are available for this. Depression is a very serious mental health disorder as it leads to suicidality if not promptly treated. The self-isolation that accompanies and defines it also means that the affected person cannot function both socially and in their occupation. This brings about a heavy economic burden (Greenberg et al., 2015). Treatment of depression takes several forms, both pharmacological and psychotherapeutic (Fekadu et al., 2017; Gautam et al., 2017). This paper discusses organizational readiness for change in an organization that intends to carry out a change initiative in the way depression is treated. Organizational Readiness and Problem Statement Essay Paper
Section A: Assessment of the Organizational Culture and Change Readiness
Evidence-based practice (EBP) is the driving force behind exceptional patient outcomes. For this reason, organizations take any EBP change initiative very seriously because it affects the very reason the organization is in existence (Melnyk & Fineout-Overholt, 2019). Assessing the readiness for change of an organization as well as its culture requires a scientific process and tool. This is the instrument that is used to interview the organization’s employees to gain an insight into their perceptions about how the organization is run and if they are willing to accept and implement change for the betterment of the organization and the services that it delivers. In this case, the instrument chosen is a Likert-type questionnaire with short questions whose answers range from “completely agree” to “completely disagree”. The tool is referred to as the Organizational Culture and Readiness for System-Wide Implementation of EBP or OCRSIEP.
In the organization in question, this instrument was employed to assess the readiness of its employees. It was found that a majority of them view the organization in favorable light as far as employee empowerment and workplace psychological safety is concerned. Most of them also agreed that they would do anything to make the organization better. This is because they felt that they are part and parcel of the organization from the way they are treated. Almost all of them also stated that they do not have any turnover intention in the foreseeable future. In other words, the employees (healthcare workers) within this organization overwhelmingly agreed that they would gladly be part of any change initiative. It was clear that all the positivity and the prevailing organizational culture of change acceptance were largely due to the organization’s transformational leadership. Since getting the buy-in of the employees would not be a problem as per the results of the OCRSIEP survey, the next step is to define the problem by stating it unequivocally. Possible barriers include insufficiency of funds and potential IRB disapproval since the intervention may be viewed as denial of treatment to a cohort of the patients. Project facilitators include availability within the employee ranks of baccalaureate nurses conversant with EBP and research who will guide the others, and the presence of transformational nurse leaders who motivate and inspire. To strengthen its weak EB areas, the organization always encourages the use of clinical inquiry and the PICOT model.
Section B: Problem Statement and Literature Review
Depression is one of the mental health conditions whose diagnostic criteria can be found in the group of disorders labelled ‘Depressive Disorders’. That is in the fifth and latest edition of the Diagnostic and Statistical Manual of Mental disorders or DSM-5 (Sadock et al., 2015; APA, 2013). Depression affects 264 million persons globally. Of these, 0.8 million die each year as a result of suicide. A good number of these are women and adolescents. Despite the availability of pharmacological and nonpharmacological therapies and treatments, a whopping 85% of persons suffering from depression do not receive treatment for it. The majority of them are persons of low socio-economic status around the world (WHO, 2020). Treatment of depression in the United States follows guidelines provided by the American Psychological Association (2019). According to Olfson et al. (2016), up to 50% of all depressed persons in the US have never received any treatment for their condition. The problem that this change initiative seeks to address is the preferred treatment of depressed women between cognitive behavioral therapy (CBT) and medications known as selective serotonin reuptake inhibitors or SSRIs (Stahl, 2017).
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The PICOT Statement
The refined PICOT statement for this project is: In women with depression (P), does the use of CBT and SSRIs (I) compared to SSRIs alone (C) produce better symptom remission (O) within a timeframe of 6 months (T)? The research summary on this problem is therefore as follows:
- The subjects are women of all ages suffering from depression.
- The method used is that of clinical inquiry employing the PICOT model. Databases searched include Cochrane, ProQuest, PubMed, CINAHL, and Embase.
- The key findings from the search are that a combination of CBT and SSRIs such as sertraline (Zoloft) produces better remission of symptom than using the SSRIs alone (American Psychological Association, 2019; Gautam et al., 2017; Fekadu et al., 2017).
- The limitation that may hinder complete evaluation is the limited timeframe for implementation . Organizational Readiness and Problem Statement Essay Paper
References
American Psychological Association [APA] (2019). Clinical practice guideline for the treatment of depression across three age cohorts: Guideline development panel for the treatment of depressive disorders. https://www.apa.org/depression-guideline/guideline.pdf
American Psychological Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Author.
Fekadu, N., Shibeshi, W., & Engidawork, E. (2017). Major depressive disorder: Pathophysiology and clinical management. Journal of Depression and Anxiety, 6(1), 1-7. https://doi.org/10.4172/2167-1044.1000255
Gautam, S., Jain, A., Gautam, M., Vahia, V.N., Grover, S. (2017). Clinical practice guidelines for the management of depression. Indian Journal of Psychiatry, 59(Suppl 1), S34-S50. http://dx.doi.org/10.4103/0019-5545.196973
Greenberg, P.E., Fournier, A-A., Sisitsky, T., Pike, C.T., & Kessler, R.C. (2015). The economic burden of adults with major depressive disorder in the United States (2005-2010). Journal of Clinical Psychiatry, 76(2), 155-162. http://dx.doi.org/10.1016/j.psc.2011.11.005
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.
Olfson, M., Blanco, C., & Marcus, S.C. (2016). Treatment of adult depression in the United States. JAMA Internal Medicine, 176(10), 1482-1491. http://dx.doi.org/10.1001/jamainternmed.2016.5057
Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11th ed. Wolters Kluwer.
Stahl, S.M. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide, 6th ed. Cambridge University Press.
World Health Organization [WHO] (2020). Depression. https://www.who.int/news-room/fact-sheets/detail/depression Organizational Readiness and Problem Statement Essay Paper