Clinical Change Project: A Summary of the Project Paper

Clinical Change Project: A Summary of the Project Paper

Recommendations and Conclusions

This project sought to assess the efficacy of ketamine therapy as compared to electroconvulsive therapy in individuals with treatment-resistant depression. The foundation of this undertaking rests upon two distinct care models inspired by nursing theories. Consequently, the primary aim of this study is to provide an intricate examination of the problem at hand through conceptual frameworks. For guidance thus far, Orlando’s Nursing Process Discipline Theory and the Tidal Model of Mental Health Recovery have been instrumental in shaping the theoretical framework underpinning this project initiative. In this section of the project, there is a focus on summarizing the overall project, highlighting key points and discoveries. Additionally, it emphasizes the importance of this project for advancing the nursing profession in advanced practice roles. Moreover, it presents recommendations for future research that can build upon these findings and contribute to further advancements in nursing knowledge. The purpose of this paper is to describe the project recommendations and implications for clinical practice, discuss the limitations of the study, and link the framework to the overall project.

Project Recommendations

According to the research analysis, there is evidence suggesting that both ketamine therapy and electroconvulsive therapy hold the potential to effectively treat treatment-resistant depression. Ketamine stands out due to its distinctive way of working by blocking glutamate and NMDA receptors while also modulating AMPA receptors, which contribute to its ability to alleviate depressive symptoms. Nonetheless, it should be noted that various studies have reported inconsistent findings regarding the immediate antidepressant effect of ketamine on TRD patients (Ekstrand et al., 2022). This discrepancy persists despite ketamine’s recognized anti-inflammatory properties. This project recommends the use of ketamine therapy as an alternative for patients who do not wish to undergo electroconvulsive therapy. Based on this project’s analysis of the current issue and preexisting resources, it is clear that multiple approaches and interventions can be considered in managing treatment-resistant depression.

One effective way to improve outcomes is by developing customized treatment strategies for each patient (Anand et al., 2023). By taking into account their unique characteristics, such as response to prior therapies, coexisting conditions, and personal preferences, care providers can create a tailored approach that acknowledges the fact that one-size-fits-all treatments may not be effective for everyone. A great addition to current practice would be incorporating ketamine therapy into the treatment plan for individuals with TRD. This innovative approach has shown promising results and could provide additional benefits compared to traditional methods alone.

Implications for Clinical Practice

The findings of this project have significant implications for the field of clinical practice, particularly in advanced nursing. The utilization of Advanced Practice Registered Nurses can lead to the development and implementation of personalized treatment plans tailored specifically to patients with Treatment-Resistant Depression. These plans will take into account individual characteristics, treatment history, and patient preferences. APRNs should consider incorporating ketamine therapy as part of the comprehensive treatment approach for TRD patients who have not responded positively to traditional treatments. By integrating ketamine therapy into their care strategies, healthcare professionals may increase the likelihood of successful outcomes and alleviate depressive symptoms effectively. This project assists healthcare providers in selecting appropriate candidates for ketamine.

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Limitations of the Study

This project drew information, conclusions, and resources from high evidence levels studies, including clinical trials, systematic reviews, and meta-analyses. A total of 11 studies were used to draw conclusions and recommendations for this project. Although the valuable knowledge gained from this study is commendable, it is crucial to recognize its inherent limitations. These restrictions encompass a limited pool of studies included in the literature review, inconsistencies in research methodologies employed across different sources, and potential biases within those reviewed materials. Furthermore, it should be noted that the available data may not provide a comprehensive overview of all facets of the effectiveness of treatment for TRD, especially adverse events and effects. Side effects are some of the commonest causes of noncompliance to treatment and thus determine the patient satisfaction and experience of the care offered.

The project has employed two theoretical frameworks, the Adaptation Model and the Humanistic Nursing Theory, to gain a comprehensive understanding of how effective treatment for TRD can be achieved by taking into account patient adaptation and experiences. These theories do not entirely define the entire project. Nonetheless, there is room for further exploration in future research, where additional nursing theories or models could be utilized to address specific aspects of TRD care and enhance patients’ experiences. Considering the results, public policies and clinical practice guidelines must take into account the potential advantages that ketamine therapy and ECT could bring in treating TRD (Bennabi et al., 2019). Creating an environment that fosters collaboration among healthcare professionals from various disciplines while incorporating patient preferences when making treatment choices can greatly enhance the quality of care and overall patient outcomes. By prioritizing these factors, this implementation can ensure a more personalized approach to treatment that addresses.  individual needs and ultimately leads to improved results by incorporating nursing, anesthesiology, and mental health.

Tying the Theories to the Project

Both theories underscore the importance of implementing the nursing process to deliver optimal patient care and prioritize a patient-centric approach. These theories stress customizing nursing interventions per patients’ immediate requirements. In my endeavor, I aim to employ these principles while evaluating ketamine therapy and ECT interventions for depression cases unresponsive to conventional treatment options. When individuals are unable to independently meet their needs, it can evoke feelings of helplessness within them. The primary objective is to enhance the overall well-being of patients by addressing their circumstances effectively. Nurses are not assessed based on their actions alone but rather on their ability to facilitate effective communication and meet the patient’s needs.

Each interaction with a patient necessitates personalized support from the nurse to determine the most appropriate way to assist them. Nurses must address each individual’s unique characteristics when providing care. This approach serves as a comprehensive framework that guides the selection of treatment options such as ketamine or electroconvulsive therapy. The effectiveness of these treatment strategies would be evaluated based on how well they alleviate depressive symptoms in patients. However, it is important to note that prioritizing patient-centeredness remains essential throughout this process.

Conclusion

To sum up, the primary goal of this study was to evaluate how effective ketamine therapy and ECT are in treating TRD patients by utilizing nursing theories as conceptual frameworks. The results indicate that both treatments demonstrate potential in managing TRD; however, further investigation is necessary to comprehensively comprehend their mechanisms of action and possible drawbacks. The project’s implications on clinical practice, suggestions for future research, and examination of theoretical constructs significantly contribute to enhancing the advanced practice nursing field’s ability to effectively address TRD from a holistic standpoint.

References

Anand, A., Mathew, S. J., Sanacora, G., Murrough, J. W., Goes, F. S., Altinay, M., Aloysi, A. S., Asghar-Ali, A. A., Barnett, B. S., Chang, L. C., Collins, K. A., Costi, S., Iqbal, S., Jha, M. K., Krishnan, K., Malone, D. A., Nikayin, S., Nissen, S. E., Ostroff, R. B., … Hu, B. (2023). Ketamine versus ECT for nonpsychotic treatment-resistant major depression. The New England Journal of Medicine, 388(25), 2315–2325. https://doi.org/10.1056/nejmoa2302399

Bennabi, D., Charpeaud, T., Yrondi, A., Genty, J.-B., Destouches, S., Lancrenon, S., Alaïli, N., Bellivier, F., Bougerol, T., Camus, V., Dorey, J.-M., Doumy, O., Haesebaert, F., Holtzmann, J., Lançon, C., Lefebvre, M., Moliere, F., Nieto, I., Rabu, C., … Haffen, E. (2019). Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the foundation FondaMental. BMC Psychiatry, 19(1). https://doi.org/10.1186/s12888-019-2237-x

Ekstrand, J., Fattah, C., Persson, M., Cheng, T., Nordanskog, P., Åkeson, J., Tingström, A., Lindström, M. B., Nordenskjöld, A., & Movahed Rad, P. (2022). Racemic ketamine as an alternative to electroconvulsive therapy for unipolar depression: A randomized, open-label, non-inferiority trial (KetECT). The International Journal of Neuropsychopharmacology, 25(5), 339–349. https://doi.org/10.1093/ijnp/pyab088

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This part of your paper includes the summary of the project, main points and findings, the significance of the project to the advanced practice nursing profession, and recommendations for future research. Address the following:

Address your recommendations and implications for clinical practice.

Provide a summary of study and discuss any limitations of the study.

Suggest directions for future research.

Consider changes in theoretical constructs

Provide suggestions for public policy and/or changes in practice.

Tie the theoretical framework to the overall product.

Conclude with an overall wrap-up to the paper.

Your paper should be 4–5 pages in length, not including the cover or reference pages. You must reference a minimum of two scholarly sources in your paper.