A report by the Institute of Medicine (IOM) introduced five core competencies for health professionals: provide patient-centered care, work in interdisciplinary teams, employ evidence-based practice, apply quality improvement, and utilize informatics (Institute of Medicine of the National Academies, 2003). The objective of the report was to improve the United States health care system. IOM proposes that if all five core competencies are utilized by health professionals, quality patient care can be achieved.
Integrating Evidence-Based Practice
To implement a new screening system for depression, all clinic staff will be educated on the importance of recognizing depression in hemodialysis patients. Furthermore, all team members of the interdisciplinary team will have a clear understanding of their role in this new screening procedure. The selected tool in the screening process is BDI. For current patients, the initial screening process will be done at chair side when the nurse is performing either the pre or post hemodialysis assessment. New patients, on the other hand, will be screened during the admittance process. Once the initial screening is done, patients will be re-screened every six months. According to Battistella (2012), the most effective way of recognizing the early onset of depression is to do screenings when the patient first starts dialysis, then every six months or annually.
In a recent study by Keskin and Engin (2011), using BDI, they found that 40.2% of their participants with renal failure had depression. The study confirmed that depression increases significantly with age and lower educational status. Additionally, suicidal ideation is more prominent in this patient population and increases with the severity of ...
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...ave symptoms of depression, however, they fail to recognize their symptoms and/or believe the need for treatment is unnecessary. Due to the prevalence of depression in ESRD patients and the decrease in quality of life, screening for depression is essential in the hemodialysis center.
The most utilized tool in clinics and research in the evaluation of depression is BDI; not only does BDI evaluate depressive affect it also evaluates cognitive content (Keskin & Engin, 2011). The survey has 21 questions: two questions on emotions, 11 on cognition, two on behavior, five on physical signs, and one on interactive signs. The questions are scored on a scale from zero to three, with a total score ranging from zero to 63. A score less than nine indicates absent or minimal depression, 10 to 18 mild depression, 19 to 29 moderate depression, and greater than 30 severe depression.
Ms. Bardsley functions as a hemodialysis liaison and leader in clinical practice with the following roles: charge nurse, preceptor, and mentor for her colleagues. She is the resource person for the Hct-Line monitoring tool. The tool is used to monitor patient’s fluid removal during treatment to avoid hypotensive episodes associated with decreased perfusion to the heart. She routinely monitors the patient outcomes which to date has resulted in 0 admissions. She recently updated the policy to make it more user friendly for the staff and to maintain staff competency.
The Beck Depression Inventory-II (BDI-II) is the latest version of one of the most extensively used assessments of depression that utilizes a self-report method to measure depression severity in individuals aged thirteen and older (Beck, Steer & Brown, 1996). The BDI-II proves to be an effective measure of depression as evidenced by its prevalent use in both clinical and counseling settings, as well as its use in studies of psychotherapy and antidepressant treatment (Beck, Steer & Brown, 1996). Even though the BDI-II is meant to be administered individually, the test administration time is only 5 to 10 minutes and Beck, Steer & Brown (1996) remark that the interpretive guidelines presented in the test manual are straightforward, making the 21 item Likert-type measure an enticing option to measure depression in appropriate educational settings. However it is important to remember that even though the BDI-II may be easy to administer and interpret, doing so should be left to highly trained individuals who plan to use the results in correlation with other assessments and client specific data when diagnosing a client with depression. An additional consideration is the response bias that can occur in any self-report instrument; Beck, Steer & Brown (1996, pg. 1) posit that clinicians are often “faced with clients who alter their presentation to forward a personal agenda that may not be shared.” This serves as an additional reminder that self-report assessments should not be the only assessment used in the diagnoses process.
The following study will be concerned with the assessment of depression. In particular we will examine the Montgomery and Asberg Depression rating scale (MADRS).
The Beck Depression Inventory is a self-report inventory that attempts to understand the severity of depression in adults and or adolescents. The original Beck Depression Inventory was created in 1961 by Aaron Beck and his associates and was revised in 1971. In 1971, the Beck Depression Inventory was introduced at the Center for Cognitive Therapy, CCT, at the University of Pennsylvania Medical School. Much of the research on the Beck Depression Inventory has been done at the University of Pennsylvania Medical School. In the current version, of the Beck Depression Inventory, the subject rates 21 symptoms and attitudes on a 4 point scale depending on severity. Test takers rate the items listed in the inventory according to a one week timeframe, which includes the day the test takers took the test. The items that that the inventory measures covers cognitive, somatic, affective and vegetative dimensions of depression and although it was developed atheoretically, the items correspond with depression symptoms as outlined in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV, American Psychiatric Association, 1994). The Beck Depression Inventory is widely known and is well known by psychiatric populations and clinicians. The BDI can be administered in a group or individual format by oral or written form. The 1993 version targets more trait aspects of depression versus the previous and earlier versions measured state aspects of depression. The test is to be administered with no more than 15 minutes to take the test, regardless of the mode administered. The 21 symptoms that are rated on the 4 point scale are then totaled and the range can vary from 0 to 63. Patients that score...
Healthcare is a continuous emerging industry across the world. With our ever changing life styles and the increased levels of pollution across the world more and more people are suffering from various health issues. Nursing is an extremely diverse profession and among the highest educated with several levels ranging from a licensed practical nurse (LPN) to a registered nurse (RN) on up to a Doctorate in Nursing. Diane Viens (2003) states that ‘The NP is a critical member of the workforce to assume the leadership roles within practice, education, research, health systems, and health policy’.
The word ‘depression’ has become a common everyday word. We hear the term ‘depression’ so frequently today, it’s even used in the contexts of jokes. For example you may hear someone say ‘My favorite show is over, now I have nothing to watch, I’m so depressed’. Obviously this person is not depressed, but we have come to overuse it in our expressions, to the point that is takes away from the seriousness of this disorder. Major depressive disorder is a mood disorder characterized by at least two weeks of depressed mood or loss of interest in nearly all activities, along with sleep or eating disturbances, loss of energy, and feelings of hopelessness (Kosslyn, Rosenberg, 2006). This mood disorder is characterized by a depressed mood, lack of interest in activities normally enjoyed, and feeling of worthlessness. Over the course of two weeks, someone who is suffering with major depressive disorder can experience symptoms such as significant weight loss, daily insomnia or hypersomnia, loss of energy, diminished ability to think or concentration, and recurrent thoughts of death or suicide (Kosslyn, Rosenberg, 2006).
Certain practical issues need to be considered by the clinician during the assessment of MDD, (Dozois & Dobson, 2009). Depressed individuals tend to express their problems in a detailed manner when they are aware of what is expected from them during initial phase of assessment. Warning depressed clients about the possible interruptions at the initial phase along with providing them rationale helps to improve the effectiveness of the assessment (Dozois & Dobson, 2009). As depressed individuals tend to commit cognitive bias (Dozois & Beck, 2008), it is necessary to determine the actual impairment by evaluating patient’s daily routine in terms of different areas of functioning. Each diagnostic criteria needs to be addressed in number of ways (Shea, 1988). Sometimes, the patient describe their symptoms in more idiosyncratic way. So, the clinician needs to translate those concerns in to the nosological system (Dozois & Dobson, 2009). Bolland & Keller (2009) emphasize the need to assess the number of previous episodes and their duration because this information is one the predictor for risk of subsequent relapse (Solomon et al, 2000). Dozois & Dobson (2009) have reported to rely upon information related to previous episode carefully as the client may commit the reporting bias. The reporting bias can be reduced by ensuring that the patient understands the time frame to which he or she refers (Dozois & Dobson, 2009) and providing contextual cues to the patient’s memory (Shea, 1988). The information related to previous treatments, medical history, patient’s motivation for change, etc. may help in identifying resources for change (Dozois & Dobson, 2009). It is also helpful to assess client’s strengths which will help in formulating...
Major depressive disorder is more than just sadness; it is a mood disorder, which is characterized by feelings of hopelessness, depressed mood, and a reduced ability to enjoy life. The symptoms of depression fall into five categories: affective, motivational, cognitive, behavioral, and physical. People suffering from depression may experience several symptoms, for at least two weeks, in any or all of the above categories, depending on personal characteristics and the severity and type of depression. They generally have feelings of sadness, emptiness, pessimism, hopelessness, worthlessness or unreasonable guilt; lack of interest and pleasure in daily activities, reduced energy and vitality. The cognitive ability of the brain is also affected; thinking becomes slower, concentration becomes more difficult, memory lapses and problems with decision making become obvious. Individuals , may have difficulty going to sleep or experience early morning awakenings. Some other patients may feel an excessive need for sleep, and some may be troubled by dreams that carry the depressive tone into sleeping hours, causing abrupt awakening due to distress. Appetite changes are very frequent; a total loss of appetite is common and it is associated with weight loss. The same individuals who oversleep when depressed also tend to overeat. Finally, physical complaints are common and may or may not have a physical basis. Physical symptoms can occur in any part of the body and can include pain (headache, backache), gastrointestinal problems (nausea, stomach pain, diarrhea, and constipation), and neurologic complaints (dizziness, numbness, memory problems) as well as recurrent thoughts of death and contemplation of suicide.
“In depressive disorders, sadness and despondency are exaggerated, prolonged, or unreasonable. Signs of a depressive disorder are dejection, hopelessness, and an inability to feel pleasure or to take interest in anything. Other common symptoms are fatigue,...
suggested. This is particularly important if the depression is judged to be severe or if there have been some suicidal concerns.
Depression is a psychological disease. It is one of the most common mental illnesses (Blais, et al., 2013). Depression was known since antiquity. Hippocrates diagnosed it in fourth century BC (McNamara and Horan, 1986). After World War II, depression was described as “aggression turned inward” (McNamara & Horan, 1986). Now there is Hamilton Depression Rating Scale, which is designed to evaluate how severe is depression (Gibbons et al., 2012).
The two competencies that is most important to future nursing practice are patient centered care and informatics and technology.Patient centered care will definitely be important to future nursing practice because as a nurse you will need to communicate to the patient and family members, in other to achieved
Depression is much more common than most people think. Because it is essentially an invisible illness and is largely in the mind, it is difficult to correctly diagnose it and most people suffer for months, years, or even decades with depression. The Merriam-Webster Dictionary defines depression as “a mood disorder marked especially by sadness, inactivity, difficulty with thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes suicidal thoughts or an attempt to commit suicide.” Most medical definitions are able to explain what happens and why it does, but after carefully examining this one, we only notice that it explains what happens, but not why. Usually, the symptoms of an illness are...
Depression among dialysis patients is very common, but yet it isn’t always black and white when coming to diagnosing and treating it. Fortunately the growing number of nephrology social workers is helping address the needs of this unique population that is misunderstood by the general population. Johnstone says, yet the ESRD population continues to be complicated and fragile, and often poorly served outside of the dialysis clinic. It is this recognized reality that calls upon nephrology professionals to think outside of the box and continue to find creative and brief approaches for serving the underserved needs of this unique population. In essence there is a need for nephrology social workers.
Mental health professionals classify depression as a disorder that affects a person’s thoughts and feelings. “At some point during their lifetime, depression plagues 17 percent of U.S. adults.” (Myers, 2006 p. 621) In the year 2000, 76% of college students felt “overwhelmed” and 22% were unable to function as a result of their depression (American College Health Association, 2001). Major depressive disorder is characterized by extreme...