Evidence Based Nursing

This document discusses the assessment of an organization's readiness for evidence based practice implementation in the military and counseling departments. It also explores strategies to integrate clinical inquiry and proposes a psychological intervention to reduce symptoms of depression and post traumatic stress disorder (PTSD) among military veterans.

Running head: EVIDENCE BASED NURSING
Evidence based nursing
Name of the student:
Name of the University:
Author’s note

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Section A: Organizational Culture and Readiness Assessment
To assess an organization’s readiness for EBP (Evidence based practice)
implementation, the military and counselling departments at the military was selected for
conducting the survey. The organizational culture survey tool that was used included the
Organizational Culture Assessment Instrument (OCAI), which assesses whether the
organization has internal focus or external focus, stability and control or flexibility or
discretion. The following outcomes were obtained regarding the organization’s readiness for
implementing the EBP:
Facilitators: The organization had an internal focus which was to maintain high quality of
care and provide positive care experience to consumers. The organization is also flexible and
changes it infrastructure based on its needs. This outcome can act as facilitator in
implementing EBP because integrating mindfulness based therapy for military veterans will
be easier in the selected organization.
Barriers: Some of the barrier to integration is that currently the organization does not have
staffs to implement mindfulness based therapy. This would require a separate room with
desired environment as well as a qualified mental health therapist who could deliver the
sessions. Lack of availability of tools for suicide ideation assessment is also a barrier
currently.
Strategies to integrate clinical inquiry: To integrate clinical inquiry in the selected setting
based on the PICOT statement, it is planned to recruit few experiences mental health
therapist. This will help in implementing and testing the effect of intervention in large
military veterans groups. Furthermore, there is also a need to involve support staffs with
knowledge about various tools so that suicide ideation assessment and diagnosis of

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depression or other mental health issues in military veterans can be adequately done. The role
of leadership in bringing the change also needs to be observed as leader’s insight and
perception regarding embracing new innovation would help in introducing the new
intervention in the selected setting. There is also a need to fulfil informed consent
requirement with military veterans so that their support and contribution enhances the
outcome of the EBP (Brownson et al., 2017).
Section B: Proposal/Problem Statement and Literature Review
Problem statement:
In response to the issue of mental health issues in military veterans due to exposure to
trauma and continuous period of traumatic event, the PICOT statement that was framed was
‘Can psychological intervention help in the reduction of symptoms of depression and post
traumatic stress disorder among military veterans within one year?. Research in this area
will be important because posttraumatic stress disorder (PTSD) and depression is a common
phenomenon in military veterans. Goldstein et al. (2017) demonstrated deleterious effect of
traumatic military experiences of symptoms of PTSD and depression. Bryan et al. (2015)
reported increased risk for suicidal thoughts and behaviours in military veterans with
comorbid symptom of PTSD and depression. Hence, these research evidences justifies the
need to evaluate whether psychological interventions can alleviate sufferings and reduce
symptom of depression in military veterans or not. By researching on this topic, it is expected
find positive mental health outcome in military veteran groups.
Study population: To support the PICOT, the research was conducted with military veterans
at high risk of suicide. The criteria set of eligibility of research participant included
assessment of suicide ideation in sample group by a suicide prevention coordinator. Only
those sample groups were included which had significant suicide risk within the past 30 days.

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To avoid influence of bias and confounding factors, military veterans with cognitive deficits
and symptom of hallucination and disruptive behaviour has been excluded.
Method: The effectiveness of mindfulness based cognitive therapy in preventing suicidal
behaviour and depression in military veterans was done by means of randomized controlled
trial (RCT). RCT was selected as a research design for this study because it is appropriate
research design when the purpose of research is to evaluate effectiveness of an intervention
and determine cause and effect relationship between intervention and outcome (Deaton &
Cartwright, 2018). Hence, RCT method helped in evaluating the intervention of mindfulness
based cognitive therapy and its consequent outcome like reduction in suicide ideation and
improvement in depressive symptoms. Another advantage of taking this research design is
that it is the most rigorous and high quality research design coming under top level of
evidence hierarchy. The main reason for selecting mindfulness based therapy as an
intervention for this study is that literature review on the PICOT question revealed that this
intervention has been highly implemented in the target population group.
The chosen intervention was implemented in two groups. The first group received
mindfulness based therapy and other group received usual treatment. The treatment as usual
group just received 4 weekly mental health visits instead of mindfulness based therapy. The
primary outcome measure that was evaluated included suicide related events and reduction in
suicide ideation. The level of depression was also measured by means of Beck’s Depression
Inventory. The tool has high consistency and validity too. Suicidal events were defined as
those resulting in self directed violence.
Key findings:
The study was done with 80 military veteran groups and significant improvement in
suicide ideation and depression related outcome was found for the intervention group. In

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contrast, the treatment as usual group were found to have little or no improvement in suicide
ideation related behaviour. The main reason behind success of the intervention is that
mindfulness based therapy targets suicidal behaviour and it is widely used in suicide
prevention efforts. Furthermore, 10 sessions of the therapy were provided to the intervention
group and this is adequate to change suicidal thought and promote positive thinking in
population group. The outcome is also consistent with other research as King et al. (2016)
indicates that mindfulness therapy is it reduces PTSD symptoms and improves quality of life
of patient.
Limitation:
Some of the limitations of the research were that the research was done only in a
single centre and this might affect the generalizability of the finding. Although the sample
size was adequate, however the research should have been conducted in multiple setting to
ensure that the intervention can be implemented without any disruption in all setting.

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References:
Brownson, R. C., Baker, E. A., Deshpande, A. D., & Gillespie, K. N. (2017). Evidence-based
public health. Oxford University Press.
Bryan, C. J., Roberge, E., Bryan, A. O., Ray-Sannerud, B., Morrow, C. E., & Etienne, N.
(2015). Guilt as a mediator of the relationship between depression and posttraumatic
stress with suicide ideation in two samples of military personnel and
veterans. International Journal of Cognitive Therapy, 8(2), 143-155.
Deaton, A., & Cartwright, N. (2018). Understanding and misunderstanding randomized
controlled trials. Social Science & Medicine, 210, 2-21.
Goldstein, L. A., Dinh, J., Donalson, R., Hebenstreit, C. L., & Maguen, S. (2017). Impact of
military trauma exposures on posttraumatic stress and depression in female
veterans. Psychiatry research, 249, 281-285.
King, A. P., Block, S. R., Sripada, R. K., Rauch, S., Giardino, N., Favorite, T., ... & Liberzon,
I. (2016). Altered default mode network (DMN) resting state functional connectivity
following a mindfulness‐based exposure therapy for posttraumatic stress disorder
(PTSD) in combat veterans of Afghanistan and Iraq. Depression and anxiety, 33(4),
289-299.