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This is a three part assignment step on is posted I completed it step 2 is creating backgroung questions for depression on adolescents age 14 to 17 middle adolescents the 3 step is posting one page this is what I'm doing this how I'm doing it this is what I hope to achieve and do you have any suggestiond type og paper. step 4 2 to 3 page paper off of chapter two which is posted in the paper read the instructions and good luck

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The parts of your paper should include: Introduction Definition Epidemiology Clinical Presentation Complications Diagnosis Conclusion with PICOT Question Background Question You will be looking for overview/background information and you will need to answer a BACKGROUND QUESTION with general knowledge about a disorder or topic. “What you know.” Background information may be found in sources such as: • • • • reference book entries • textbooks, chapters, appendices • drug monographs, guides to diagnostic tests • the library • selected in the health sciences Asks for general information about a clinical issue Usually has two components: 1. The starting place of the question (e.g., what, where, when, why, and how) 2. The outcome of interest Broader in scope than a foreground (PICOT) question Foreground questions (PICOT format) • • • Asks for specific scientific evidence about diagnosing, treating, or educating patients The focus is on specific knowledge Use of PICOT format is recommended for a focused literature search Foreground questions are clinical questions that can only be answered by specific scientific evidence that is usually found in original studies or systematic reviews of original studies (e.g., RCTs). This type of evidence is not available in textbooks, which are more appropriate for answering background questions. Scoping Search A Background search also called a Scoping Search: Background Questions: This is where you do an extensive exploration of the topic of choice—with a disease issue ie: heart disease or depression the following questions must be answered. With a clinical issue the exploration must be exhaustive based on the topic. Background questions, ask about general knowledge about a disorder or topic. A scoping search begins to locate general knowledge about a topic. Expert opinions, pre-synthesized and pre-appraised guidelines, summaries. To insure a complete understanding of the issue a clinical background question would include the following: • • • • • • Definition Epidemiology Clinical Presentation Complications Diagnosis Conclusion And, this will lead to the PICOT question. Barriers to EBP • • • • • • Clinical Inquiry must be cultivated in the work environment and in the presence of uncertainty. Uncertainty is the inability to predict what an experience will mean or what outcome will occur. In the face of uncertainty and clinical inquiry clinicians must be able to find the right information at the right time—thus setting up specific barriers to EBP. Access tends to be the biggest barrier. Access to computers on the unit, access to electronic resources and information and access to time to search for the best evidence to answer our questions. Additional barriers include nurses’ comfort level in searching the library and search technology and skills in developing a strong researchable question. What other barriers can you think of? Chapter 2 Asking Compelling, Clinical Questions Ellen Fineout-Overholt and Susan B. Stillwell A prudent question is one-half of wisdom. —Francis Bacon Seeking and using health information has changed over the past several decades, not only for healthcare professionals (e.g., the Internet; electronic health records with evidence-based clinical decision support systems; Ferran-Ferrer, Minguillón, & Pérez-Montoro, 2013) but also for patients, who are moti- vated to access health information via the web (Shaikh & Shaikh, 2012). Over the past few years, significant strides have been made to make digital health information even more readily available, thus leading to informed clinical decisions that are evidence based (Institute of Medicine, 2011). In addition, growing complexity of patient illness has required practitioners to become increasingly more proficient at obtaining information they need when they need it. Access to reliable information is necessary to this endeavor (Kosteniuk, Morgan, & D’Arcy, 2013) as well as clinicians definitively identifying what they want to know and what they need to access (Fineout-Overholt & Johnston, 2005; Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2010). Additionally, resources (e.g., computers, databases, and libraries) have to be in place to ensure that prac- titioners can retrieve needed information so that they can perform the best patient care possible. Not all practice environments have or allow unrestricted access to these resources. There are many variables that influence whether a practitioner has the capacity to gather information quickly (e.g., financial ability to purchase a computer, availability of Internet service providers); however, every clinician must be able to articulate the clinical issue in such a way that it maximizes the information obtained with the least amount of time investment. Hence, the first step in getting to the right information is to determine the “real” clini- cal issue and describe it in an answerable fashion, that is, a searchable, answerable question. However, skill level in formulating an answerable question can be a barrier to getting the best evidence to apply to practice (Gray, 2010; Green & Ruff, 2005; Rice, 2010). This chapter provides practitioners with strategies to hone skills in formulating a clinical question to clarify the clinical issue and to minimize the time spent in searching for relevant, valid evidence to answer it. A NEEDLE IN A HAYSTACK: FINDING THE RIGHT INFORMATION AT THE RIGHT TIME Th e key to successful patient care for any healthcare professional is to stay informed and as up to date as possible on the latest best practices. External pressure to be up to date on clinical issues increasingly comes from patients, employers, certifying organizations, insurers, and healthcare reform (Centers for Medicare & Medicaid Services, 2006; Greiner & Knebel, 2003; Rice, 2010). The clinician’s personal desire to provide the best, most up-to-date care possible along with expectations from healthcare consumers that practice will be based on the latest and best evidence fosters evidence-based practice (EBP). However, the desire to gather the right information in the right way at the right time is not suffi cient. Practical, lifelong learning skills (e.g., asking focused questions, learning to search efficiently) are required to negotiate the information-rich environment that every clinician encounters. With the amount of information that clinicians have at their disposal today, finding the right information at the right time is much like weeding through the haystack to find the proverbial needle. If one has any hope of finding the needle, there must be some sense of theneedle’s characteristics (i.e., a clear understanding of what is the clinical issue). Clinical questions arise from inquiry. Clinicians notice that there is something curious in the clinical environment that they then formulate into a question, or a patient or layperson may foster the question. Whoever initiates the question, it is important to carefully consider how to ask it so that it is reasonable to answer. Formulating the clinical question is much like identifying the characteristics of the needle. Question components guide the search- ing strategies undertaken to find answers. Yet, clinicians are not always equipped to formulate searchable questions (Melnyk, Fineout-Overholt, Feinstein, Sadler & Green-Hernandez, 2008), which often can result in irrelevant results and inefficient use of clinicians’ time (Rice, 2010). Once the needle’s characteristics are well understood (i.e., the PICOT question), knowing how to sift through the haystack (i.e., the evidence) becomes easier (see Chapter 3 for searching strategies). Huang, Lin, and Demnar-Fushman (2006) found in a study examining the utility of asking clini- cal questions in PICOT format (i.e., P: population of interest; I: intervention or issue of interest; C: comparison of interest; O: outcome expected; and T: time for the intervention to achieve the outcome) that when clinicians asked clinical questions for their patient’s clinical issues, their format almost always fell short of addressing all the aspects needed to clearly identify the clinical issue. Two of 59 questions contained an intervention (I) and outcome (O), but no other components (P, C, or T), although these aspects were appropriate. Currie et al. (2003) indicated that approximately two thirds of clinicians’ ques- tions are either not pursued or answers are not found even though pursued. However, if properly formu- lated, the question could lead to a more effective search. Price and Christenson (2013) concur with these researchers’ findings, indicating that getting the question right determines the success of the entire EBP process. In addition, in a randomized controlled trial (RCT) examining the effect of a consulting service that provides up-to-date information to clinicians, Mulvaney et al. (2008) found that such a knowledge broker improves the use of evidence and subsequent care and outcomes. However, without having a well-built question to communicate what clinicians genuinely want to know, efforts to search for or pro- vide appraised evidence will likely be less than profitable. Hoogendam, de Vries Robbé, and Overbeke (2012) determined that the PICO(T) format was not helpful in guiding efficient searches; however, their report did not indicate how they measured proficiency of participants in writing PICOT questions or how they were taught about their formulation. Learning how to properly formulate a clinical question is essential to a successful search and to effectively begin the EBP process. The Haystack: Too Much Information Although there is a plethora of information available and increasingly new modalities to access it, news of clinical advances can diffuse rather slowly through the literature. Additionally, only a small percent- age of clinicians access and use the information in a timely fashion (Cobban, Edgington, & Clovis, 2008; Estabrooks, O’Leary, Ricker, & Humphrey, 2003; MacIntosh-Murray & Choo, 2005; McCloskey, 2008; Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012; Pravikoff, Tanner, & Pierce, 2005). Clini- cians are challenged with the task of effectively, proactively, and rapidly sifting through the haystack of scientific information to find the right needle full of the best applicable information for a patient or practice. Scott, Estabrooks, Allen, and Pollock (2008) found that uncertainty in clinicians’ work envi- ronment promoted a disregard for research as relevant to practice. In a 2012 study of over 1,000 nurses, Melnyk and colleagues reinforced these researchers’ finding with their participants indicating that lack of access to information was one of the top five deterrents to implementing EBP in daily practice. To reduce uncertainty and facilitate getting the right information at the right time, EBP emphasizes first asking a well-built question, then searching the literature for an answer to the question. This will better prepare all clinicians to actively discuss the best available evidence with colleagues and their patients. The EBP process focuses on incorporating good information-seeking habits into a daily routine. Pravikoff et al. (2005) indicated that not all nurses were engaged in daily information seeking, support- ing the notion that, in a busy clinical setting, there is seldom time to seek out information, which was reinforced in the study by Melnyk et al. (2012). The purchase of a good medical text and regular perusal of the top journals in a specialty were once considered adequate for keeping up with new information, but scientific information is expanding faster than anyone could have foreseen. The result is that signifi- cant clinical advances occur so rapidly that they can easily be overlooked. Reading every issue of the top three or four journals in a particular field from cover to cover does not guarantee that clinicians’ profes- sional and clinical knowledge is current. With the increase in biomedical knowledge (especially infor- mation about clinical advances), it is clear that the traditional notion of “keeping up with the literature” is no longer practical. Before the knowledge explosion as we know it today, Haynes (1993) indicated that a clinician would have to read 17–19 journal articles a day, 365 days a year to remain current. This com- pels every clinician to move toward an emphasis on more proactive information-seeking skills, starting with formulating an answerable, patient-specific question. Digitization and the Internet have improved accessibility to information, regardless of space and time; however, these innovations have not resolved the issue of finding the right information at the right time. It is important to become friendly with and proficient at utilizing information technology, includ- ing the Internet and other electronic information resources, which means that clinicians must be skilled in using a computer. Access to computers at the point of care is also essential. The information needed cannot be obtained if the clinician has to leave the unit or seek an office to locate a computer to retrieve evidence. Proficient use and access to computers are essential to EBP and best practice. In addition, other barriers described by nurses and other healthcare professionals to getting the right information at the right time include (a) access to information, (b) a low comfort level with library and search tech- niques, (c) access to electronic resources, and (d) a lack of time to search for the best evidence (Melnyk & Fineout-Overholt, 2002; Melnyk, Fineout-Overholt, Gallagher-Ford & Kaplan, 2012; Pravikoff et al., 2005; Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). Skills in clinical question formulation lead to an efficient search process. Other barriers to finding the necessary evidence to improve patient outcomes can be adequately addressed through clinicians first learning to ask a searchable, answerable question. The important thing is not to stop questioning. —Albert Einstein AskiNg seARcHAble, ANsweRAble QuestioNs Finding the right information in a timely way amidst an overwhelming amount of information is imper- ative. The first step to accomplish this goal is to formulate the clinical issue into a searchable, answerable question. It is important to distinguish between the two types of questions that clinicians might ask— background questions and foreground questions. Background Questions Background questions are those that need to be answered as a foundation for asking the searchable, answerable foreground question (Fineout-Overholt & Johnston, 2005; Stillwell, FineoutOverholt, Melnyk, & Williamson, 2010; Straus, Richardson, Glasziou, et al., 2005). Background questions are those that ask for general information about a clinical issue. This type of question usually has two components: the starting place of the question (e.g., what, where, when, why, and how) and the outcome of interest (e.g., the clinical diagnosis). An example of a background question is: How does the drug acetamino- phen work to affect fever? The answer to this question can be found in a drug pharmacokinetics text. Another example of a background question is: How does hemodynamics differ with positioning? This answer can be found in textbooks as well. Often, background questions are far broader in scope than foreground questions. Clinicians often want to know the best method to prevent a clinically undesirable outcome. For example: What is the best method to prevent pressure ulcers during hospitalization? This question will lead to a foreground but scientific information is expanding faster than anyone could have foreseen. The result is that signifi- cant clinical advances occur so rapidly that they can easily be overlooked. Reading every issue of the top three or four journals in a particular field from cover to cover does not guarantee that clinicians’ profes- sional and clinical knowledge is current. With the increase in biomedical knowledge (especially infor- mation about clinical advances), it is clear that the traditional notion of “keeping up with the literature” is no longer practical. Before the knowledge explosion as we know it today, Haynes (1993) indicated that a clinician would have to read 17–19 journal articles a day, 365 days a year to remain current. This com- pels every clinician to move toward an emphasis on more proactive information-seeking skills, starting with formulating an answerable, patient-specific question. Digitization and the Internet have improved accessibility to information, regardless of space and time; however, these innovations have not resolved the issue of finding the right information at the right time. It is important to become friendly with and proficient at utilizing information technology, includ- ing the Internet and other electronic information resources, which means that clinicians must be skilled in using a computer. Access to computers at the point of care is also essential. The information needed cannot be obtained if the clinician has to leave the unit or seek an office to locate a computer to retrieve evidence. Proficient use and access to computers are essential to EBP and best practice. In addition, other barriers described by nurses and other healthcare professionals to getting the right information at the right time include (a) access to information, (b) a low comfort level with library and search tech- niques, (c) access to electronic resources, and (d) a lack of time to search for the best evidence (Melnyk & Fineout-Overholt, 2002; Melnyk, Fineout-Overholt, Gallagher-Ford & Kaplan, 2012; Pravikoff et al., 2005; Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). Skills in clinical question formulation lead to an efficient search process. Other barriers to finding the necessary evidence to improve patient outcomes can be adequately addressed through clinicians first learning to ask a searchable, answerable question. The important thing is not to stop questioning. —Albert Einstein AskiNg seARcHAble, ANsweRAble QuestioNs Finding the right information in a timely way amidst an overwhelming amount of information is imper- ative. The first step to accomplish this goal is to formulate the clinical issue into a searchable, answerable question. It is important to distinguish between the two types of questions that clinicians might ask— background questions and foreground questions. Background Questions Background questions are those that need to be answered as a foundation for asking the searchable, answerable foreground question (Fineout-Overholt & Johnston, 2005; Stillwell, FineoutOverholt, Melnyk, & Williamson, 2010; Straus, Richardson, Glasziou, et al., 2005). Background questions are those that ask for general information about a clinical issue. This type of question usually has two components: the starting place of the question (e.g., what, where, when, why, and how) and the outcome of interest (e.g., the clinical diagnosis). An example of a background question is: How does the drug acetamino- phen work to affect fever? The answer to this question can be found in a drug pharmacokinetics text. Another example of a background question is: How does hemodynamics differ with positioning? This answer can be found in textbooks as well. Often, background questions are far broader in scope than foreground questions. Clinicians often want to know the best method to prevent a clinically undesirable outcome. For example: What is the best method to prevent pressure ulcers during hospitalization? This question will lead to a foregroundquestion, but background knowledge is necessary before the foreground question can be asked. In this example, the clinician must know what methods of pressure ulcer prevention are being used. Gener- ally, this information comes from knowledge of what is being used in clinicians’ practices and what viable alternatives are available to improve patient outcomes, or it may come from descriptive research, such as survey research. Once the methods most supported are identified, clinicians can formulate the foreground question, compare the two most effective methods of pressure ulcer prevention, and ask: Which one will work best in my population? If a clinician does not realize that the question at hand is a background question, time may be lost in searching for an answer in the wrong haystack (e.g., electronic evidence databases versus a textbook). Foreground Questions Foreground questions are those that can be answered from scientific evidence about diagnosing, treat- ing, or assisting patients in understanding their prognosis. These questions focus on specific knowl- edge. In the first two background question examples, the subsequent foreground questions could be: In children, how does acetaminophen compared to ibuprofen affect fever? And: In patients with acute respiratory distress syndrome, how does the prone position compared to the supine position affect hemodynamic readings? The first question builds on the background knowledge of how acetaminophen works but can be answered only by a study that compares the two listed medications. The second ques- tion requires the knowledge of how positioning changes hemodynamics (i.e., the background question), but the two types of positioning must be compared in a specific population of patients to answer it. The foreground question generated from the third background question example could be: In patients at risk for pressure ulcers, how do pressure mattresses compare to pressure overlays affect the incidence of pressure ulcers? The answer provided by the evidence would indicate whether pressure mattresses or overlays are more effective in preventing pressure ulcers. The most effective method will become the standard of care. Recognizing the difference between the two types of questions is the challenge. Straus, Richardson, Glasziou, and Haynes (2011) stated that a novice may need to ask primar- ily background questions. As one gains experience, the background knowledge grows, and the focus changes to foreground questions. Although background questions are essential and must be asked, it is the foreground questions that are the searchable, answerable questions and the focus of this chapter. Clinical Inquiry and Uncertainty in Generating Clinical Questions Where clinical questions come from (i.e., their origin) is an important consideration. On a daily basis, most clinicians encounter situations for which they do not have all the information they need (i.e., uncertainty) to care for their patients as they would like (Kahmi, 2011; Nelson, 2011; Scott et al., 2008). The role of uncertainty is to spawn clinical inquiry. Clinical inquiry can be defined as a process in which clinicians gather data together using narrowly defined clinical parameters to appraise the avail- able choices of treatment for the purpose of finding the most appropriate choice of action (Horowitz, Singer, Makuch, & Viscoli, 1996). Clinical inquiry must be cultivated in the work environment. To foster clinical inquiry, one must have a level of comfort with uncertainty. Uncertainty is the inability to predict what an experience will mean or what outcome will occur when encountering ambiguity (Cranley, Doran, Tourangeau, Kushniruk, & Nagle, 2009; Scott et al., 2008). Although uncertainty may be uncomfortable, uncertainty is imperative to good practice (Kamil, 2011) and to developing focused foreground questions (Nelson, 2011). Clinicians live in a rather uncertain world. What works for one patient may not work for another patient or the same patient in a different setting. The latest product on the market claims that it is the solution to wound healing, but is it? Collaborating partners in caring for complex patients have their own ways of providing care. Formulating clinical questions in a structured, specific way, such as with PICOT formatting, assists the clinician in finding the right evidence to answer those questions and to decrease uncertainty. This approach to asking clinical questions facilitates a well-constructed search. Price and Christenson (2013) indicated that the PICOT question is the key to the entire EBP process. Success with PICOT question formation fosters further clinical inquiry. Clinical circumstances, such as interpretation of patient assessment data (e.g., clinical findings from a physical examination or laboratory data), a desire to determine the most likely cause of the patient’s problem among the many it could be (i.e., differential diagnosis), or simply wanting to improve one’s clinical skills in a specific area, can prompt five types of questions. The five types of foreground ques- tions are 1. intervention questions that ask what intervention most effectively leads to an outcome; 2. prognosis/prediction questions that ask what indicators are most predictive of or carry the most associated risk for an outcome; 3. diagnosis questions that ask what mechanism or test most accurately diagnoses an outcome; 4. etiology questions that ask to what extent a factor, process, or condition is highly associated with an outcome, usually an undesirable outcome; and 5. meaning questions that ask how an experience influences an outcome, the scope of a phenomenon, or perhaps the influence of culture on health care. Whatever the reason for the question, the components of the question need to be considered and formu- lated carefully to efficiently find relevant evidence to answer the question. Posing the Question Using PICOT Focused foreground questions are essential to judiciously finding the right evidence to answer them (Schardt, Adams, Owens, Keitz, & Fontelo, 2007). Foreground questions should be posed using PICOT format. Thoughtful consideration of each PICOT component can provide a clearly articulated question. Using a consistent approach to writing the PICOT question assists the clinician to systematically identify the clinical issue (Stillwell et al., 2010). Table 2.1 provides a quick overview of the PICOT question com- ponents. Well-built, focused clinical questions drive the subsequent steps of the EBP process (O’Connor, Green, & Higgins, 2011). Table 2.1 PICOT: Components of an Answerable, Searchable QuestionPICOT Patient population/disease The patient population or disease of interest, for example: • Age • Gender • Ethnicity • With certain disorder (e.g., hepatitis) Intervention or issue of interest The intervention or range of interventions of interest, for example: • Therapy • Exposure to disease • Prognostic factor A • Risk behavior (e.g., smoking) Comparison intervention or issue of interest What you want to compare the intervention or issue against, for example: • Alternative therapy, placebo, or no intervention/therapy • No disease • Prognostic factor B • Absence of risk factor (e.g., nonsmoking) Outcome Outcome of interest, for example: • Outcome expected from therapy (e.g., pressure ulcers) • Risk of disease • Accuracy of diagnosis • Rate of occurrence of adverse outcome (e.g., death) Time The time involved to demonstrate an outcome, for example: • The time it takes for the intervention to achieve the outcome • The time over which populations are observed for the outcome (e.g., quality of life) to occur, given a certain condition (e.g., prostate cancer) irritability? Instead of formulating the question this way, it may be better to use the umbrella term dehydra- tion for all these symptoms that are listed; however, clinicians would keep in mind each of the outcomes that they desired to see change. The question would then be: In preschool-age children, how does a flavored electrolyte drink compared to water alone affect dehydration (e.g., dry mouth, tachycardia, fever, irritabil- ity)? Specifying the outcome will assist the clinician in focusing the search for relevant evidence. Considering whether or not a time frame (T) is associated with the outcome is also part of asking a PICOT question. For example: In family members who have a relative undergoing cardiopulmonary resuscitation (P), how does presence during the resuscitation (I) compared to no presence (C) affect family anxiety (O) during the resuscitation period (T)? In the intervention example given earlier, there is no specific time identified for bathing or showering to achieve patient hygiene because it is immediately upon completion of these interventions. Although this is understood, it would not be incorrect to use “immediately after intervention” as the “T” for this question. However, for the meaning question example, it would be important to consider that the first month after diagnosis may be a critical time for parental role to be actualized for this population; therefore, it is essential to include a specific time in the question. To answer this meaning question, studies would be sought that collected data to evaluate parental role for a period of a month after diagnosis; studies with evaluation of parental role within less than 1 month would not be acceptable to answer the question. Time (T) and comparison (C) are not always appropriate for every question; however, population (P), intervention or issue of interest (I), and outcome (O) must always be present. Three Ps of Proficient Questioning: Practice, Practice, Practice The best way to become proficient in formulating searchable, answerable questions is to practice. This section includes five clinical scenarios that offer you the opportunity to practice formulating a search- able, answerable question. Read each scenario and try to formulate the question using the appropriate template for the type of question required (see Box 2.1 for a list of all question types and templates). Templates are guides and are designed to assist you in formulating each question and ensure that components of the question (i.e., PICOT) are not missed. Once you craft your questions, read the paragraphs that follow for help in determining the success of your question formulation. EBP FAST FACTS ◆ Background questions contain a starting place of the question (e.g., what, where, when, why, and how) and an outcome of interest. These questions ask for general information about the clinical issue. ◆ Foreground questions focus on specific information and contain the PICOT elements, for example, “P”: population of interest, “I”: intervention or area of interest, “C”: comparison intervention or area of interest, “O”: outcome of interest, and “T”: time it takes for the intervention or issue to achieve the outcome. ◆ Essential elements of a PICOT question include a “P,” “I,” and “O.” The “C” or “T” may not always be appropriate for a clinical question. The “C,” comparison, in PICOT questions is generally the usual standard of care. ◆ The purpose of the PICOT question is to hone the clinical issue and to guide the search of databases to locate the evidence to answer the clinical question. ◆ The type of PICOT question guides the desired research design search to best answer the question. Chapter 2: Asking Compelling, Clinical Questions 39 MacIntosh-Murray, A., & Choo, C. W. (2005). Information behavior in the context of improving patient safety. Journal of the American Society of Information Science & Technology, 56, 1332–1345. McCloskey, D. J. (2008). Nurses’ perceptions of research utilization in a corporate health care system. Journal of Nursing Scholarship, 40, 39–45. Melnyk, B. M., & Fineout-Overholt, E. (2002). Putting research into practice. Reflections on Nursing Leadership, 28(2), 22–25, 45. Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidencebased practice in US nurses: Critical implications for nurse leaders and educators. Journal of Nursing Administration, 42(9), 410–417. Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: step by step: The seven steps of evidencebased practice. American Journal of Nursing, 110(1), 51–53. Mulvaney, S., Bickman, L., Giuse, N., Lambert, E., Sathe, N., & Jerome, R. (2008). A randomized effectiveness trial of a clinical informatics consult service: Impact on evidence-based decision-making and knowledge implementation. Journal of the American Medical Informatics Association, 15, 203–211. Nelson, N. (2011). Questions About certainty and uncertainty in clinical practice. Language, Speech and Hearing Services in Schools, 42, 81–87. O’Connor, D., Green, S., & Higgins, J. (2011). Handbook for systematic reviews of interventions; Chapter 5 Defining the review question and developing criteria for including studies. Retrieved August 26, 2013, from http://handbook.cochrane.org Pravikoff, D., Tanner, A., & Pierce, S. (2005). Readiness of U.S. nurses for evidence-based practice. American Journal of Nursing, 105, 40–50. Price, C. & Christenson, R. (2013). Ask the right question: A critical step for practicing evidence-based laboratory medicine. Annals of Clinical Biochemistry, 50(4), 306–314. Rice, M. J. (2010) Evidence-based practice problems: Form and Focus. Journal of the American Psychiatric Nurses Association, 16(5), 307–314. Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence-based medicine: How to practice and teach EBM. Edinburgh: Churchill Livingston. Schardt, C., Adams, M. B., Owens, T., Keitz, S., & Fontelo, P. (2007). Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Medical Informatics and Decision Making, 7(16), 1–6. Schlosser, R., Koul, R., & Costello, J. (2007). Asking well-built questions for evidence-based practice in augmentative and alternative communication. Journal of Communication Disorders, 40, 225–238. Scott, S., Estabrooks, C., Allen, M., & Pollock, C. (2008). A context of uncertainty: How context shapes nurses’ research utilization behaviors. Qualitative Health Research, 18, 347–357. Shaikh, M. H., & Shaikh, M. A. (2012). A prelude stride in praxis & usages of healthcare informatics. International Journal of Computer Sciences Issues, 9(6), 85–89. Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidencebased practice. American Journal of Nursing, 110(3), 58–61. Straus, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2005). Evidence-based medicine: How to teach and practice EBM (3rd ed.). Edinburgh: Churchill Livingston. Straus, S. E., Richardson, W. S., Glasziou, P., & Haynes, R. B. (2011). Evidence-based medicine: How to teach and practice it (4th ed.). Edinburgh: Churchill Livingston. Background Question to be completed and submitteProject To complete this week, after reading chapter two in Melnyk and reviewing the lectures you submit a 2-3 page paper that explores the background of your issue. For paper #1 you will be defining this issue or disease using the literature. The parts of your paper should include: Introduction Definition Epidemiology Clinical Presentation Complications Diagnosis Conclusion with PICOT Question If you are not on a clinical tract (NP) you will explore the issue extensively to define the problem or issue you are interested in—using these headers as appropriate. Create your background question and your strategy for getting a comprehensive understanding of the clinical issue. In addition, a 1-page paper on your work as your capstone project proposal progresses, you are asked to share your progress with your peers and instructor and seek or provide guidance or share insights. Step one first part of the paper base your background questions of this paper My paper includes a study on clinical depression of adolescent females from age 14 to 17 years old in Buckhannon, WV in Upshur County. This topic interests me due to my daughter’s diagnosis of bipolar, which is a mood disorder; however she seems to suffer more from depression or the down swing of the pendulum. Depression is defined as a mental health disorder that is accompanied by loss of pleasure in hobbies and depressed mood. Types of depression include dysthymia, perinatal depression, psychotic depression, bipolar, and seasonal affective disorders ( American Psychiatric Association,2013). Signs and symptoms of depression include loss of interest in activities. Also, difficulty in making and remembering decisions is another sign. Slow movements and talking accompanied with fatigue is a symptom of depression. Another sign is that the patient loses appetite that results in weight loss. Depressed persons may at times feel guilty, worthless or helpless. In addition, they may experience insomnia, oversleeping or early-morning awakening. Lastly, a depressed person may have thoughts of death or committing suicide. For someone to be diagnosed with depression, one must show its symptoms for at least two weeks. A patient should show several symptoms of clinical depression in addition to low mood and anxiety in order to be diagnosed (CDC, 2017). Depression is a common mental health disorder. Research shows it is caused by psychological, environmental, and genetic factors. Depression occurs at any age but is commonly seen in adults. Risk factors for depression include one having stress or undergoing major life changes. Another factor is when one has a family or personal history of depression. Also, a patient with a particular illness and under medication is considered at risk of being affected by depression. Both severe and mild depression can be treated. It is advisable to get early treatment as it will be more efficient. Normally depression is treated with medications and psychotherapy. If these treatments are not effective, a doctor should resolve to use of brain stimulation therapies such as electroconvulsive therapy (ECT) (American Psychiatric Association, 2013). References American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Washington, DC: American Psychiatric Publishing; 2013. Centers for Disease Control and Prevention. (2017). Statistics and depression amongst adolescence. [Data file]. Retrieved from https://www.cdc.gov/mentalhealth/basics/mental-illness/depression.htm Reply to Thread
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Running head: DEPRESSION ON TEENAGE FEMALES

Depression on Female Teenagers
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1

DEPRESSION ON TEENAGE FEMALES

2
PART 2

Background Questions

Background questions are essential in helping to develop knowledge about depression
among female teenagers. A clinical question in regards to the matter is, what does depression
mean? This kind of clinical question is helpful in seeking an understanding of what depression is
all about. The definition can be obtained from the American Psychiatric Association online
platform which defines depression as a medical illness which is a serious and common condition
that bears negative effects to how an individual feels, the way they act as well as the way
individual acts. Depression brings feelings of loss of interest as well as sadness to the victim for
activities once enjoyed (American Psychiatric Association, 2013)

The epidemiology of depression has been researched by my scholars and other health
specialists. A lot of background questions can be generated in regards to the epidemiology of
depression. Some of the questions include, what is the prevalence of depression in the community?
Majority of the background questions under this section can be sourced from the research
conducted by Kessler and Bromet about the epidemiology of depression. According to the article,
the prevalence of depression in the US ranges to 10% of the total population. This information is
according to the study which was conducted in 2013. What is the illness course of depression? The
study states that within the general population in the US, the clinical studies conducted by the
researchers show that depressi...


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