Week 11: Synthesis and Recommendations for Implementation
Throughout the past 10 weeks, you have worked to develop a project management plan to implement a practice change for an identified or potential practice problem at your clinical site. You have explored your role as a leader in the development of this plan through your meetings with your preceptor and stakeholders, through your exploration of sources, and through your development of a communication and project management plan. These opportunities have led to this point in wherein you will put it all together to synthesize the evidence and develop your final recommendations. Synthesis And Recommendations Form Essay
This week, present your proposed change at your clinical site. You will also synthesize the evidence to develop recommendations for change implementation.
Synthesis & Recommendations Form
Table: Synthesis and process recommendations form
(i) Tool I
|EBP Question: Does the advancement of a practice framework that provides a structured approach to screening using the PHQ-A (I) lead to enhanced guidance, eagerness, and potential of providers to screen teens for depression in the practice setting (O) over a three-month period (T) among adolescents aged 12-18 years (P)?|
|Category (Level Type)||Total Number of Sources/ Level||Overall Quality Rating||Synthesis of Findings. Evidence that Answers the EBP Question|
Randomized controlled trial (RCT)
Systematic review of RCTs with or without meta-analysis
Explanatory mixed method design that includes only a Level I quantitative study
|3||These are the highest ranked evidence sources because they belong at the top of the evidence pyramid (level I of evidence). They are either systematic reviews or meta-analyses of randomized controlled trials (RCTs), or they are RCTs themselves.||Baldofski et al. (2019), Jörns-Presentati et al. (2021), and O’Dea et al. (2020) all respond to the EBP query in their level I evidence articles. They all conclude that using the PHQ-A to screen teenagers for depression and suicidality is beneficial in preventing suicides in that cohort.|
Systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis
Explanatory mixed method design that includes only a Level II quantitative study
|2||These represent the second best sources of evidence for inspiring evidence-based practice (EBP) by using the PHQ-A screening instrument in teenagers.||They present a reasonable degree of evidence for using the PHQ-A screening test to diagnose depression in adolescents. The studies by López-Torres et al. (2019) and Watson et al. (2019) are listed below (2020).|
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(ii) Tool II
|Based on your synthesis, which of the following four pathways to translation represents the overall strength of the evidence?|
|Strong and compelling evidence with consistent results. Synthesis And Recommendations Form Essay
Three of the five studies evaluated for evidence are level I evidence (LoE 1), while just two are level II evidence studies. This indicates that there is sufficient evidence to make practice modification proposals (Dang et al., 2021; White et al., 2019). The following papers or articles provide this evidence:
i. Level 1 evidence: Baldofski et al. (2019)
ii. Level 1 evidence: Jörns-Presentati et al. (2021)
iii. Level 2 evidence: López-Torres et al. (2019)
iv. Level 1 evidence: O’Dea et al. (2020)
v. Level 2 evidence: Watson et al. (2020)
|Recommendations based on evidence synthesis and selected translation pathway|
| i. As a rule, every teenager seen should be screened for depressive episodes using the PHQ-A.
ii. Use the PHQ-A tool to track improvement in therapy for teenagers who have been identified as depressed or at risk of depression using the PHQ-A tool.
iii. Community engagement initiatives to assess at-risk teenagers on a local basis.
|Consider the following as you examine fit:|
|· The preceding guidelines are compatible with the healthcare organization’s culture, methods, and procedures.
· They are also in line with its structures, attitudes, beliefs, and practices.
· Finally, the proposals are in line with the organization’s strategic goals and objectives.
|Consider the following as you examine feasibility:|
|The target demographic of professionals can, in fact, follow the recommendations at their workplace. This will equate to translation of the evidence into practice. The organization has the necessary material, human, and financial resources to carry out the recommendations. There is also enough stakeholder support and staff buy-in for implementation. Clinical leaders and administration gave their approval, along with the money allocation. With all of this, the evaluation is that the recommendations are likely to be adopted successfully within the company. Synthesis And Recommendations Form Essay|
Baldofski, S., Kohls, E., Bauer, S., Becker, K., Bilic, S., … & Rummel-Kluge, C. (2019). Efficacy and cost-effectiveness of two online interventions for children and adolescents at risk for depression (E.motion trial): study protocol for a randomized controlled trial within the ProHEAD consortium. Trials, 20(1). https://doi.org/10.1186/s13063-018-3156-8
Dang, D., Dearholt, S.L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines, 4th ed. Sigma Theta Tau International.
Jörns-Presentati, A., Napp, A.K., Dessauvagie, A.S., Stein, D.J., Jonker, D., … & Groen, G. (2021) The prevalence of mental health problems in sub-Saharan adolescents: A systematic review. PLOS ONE 16(5): e0251689. https://doi.org/10.1371/journal.pone.0251689
López-Torres, S., Pérez-Pedrogo, C., Sánchez-Cardona, I., & Sánchez-Cesáreo, M. (2019). Psychometric properties of the PHQ-A among a sample of children and adolescents in Puerto Rico. Current Psychology, 41, 90-98. https://doi.org/10.1007/s12144-019-00468-7
O’Dea, B., Han, J., Batterham, P.J., Achilles, M.R., Calear, A.L., Werner‐Seidler, A., … & Christensen, H. (2020). A randomised controlled trial of a relationship‐focussed mobile phone application for improving adolescents’ mental health. Journal of Child Psychology and Psychiatry, 1-15. http://dx.doi.org/10.1111/jcpp.13294
Watson, S.E., Spurling, S.E., Fieldhouse, A.M., Montgomery, V.L., & Wintergerst, K.A. (2020). Depression and anxiety screening in adolescents with diabetes. Clinical Pediatrics, 59(4-5), 445-449. https://doi.org/10.1177/0009922820905861
White, K.M., Dudley-Brown, S., & Terhaar, M.F. (Eds.) (2019). Translation of evidence into nursing and healthcare, 3rd ed. Springer Publishing Company.