Review of Literature – Review and discuss literature: Synthesize at least 10 primary research studies and/or systematic reviews; do not include summary artic
CAPSTONE: PART II
1. Review of Literature
– Review and discuss literature: Synthesize at least 10 primary research studies and/or systematic reviews; do not include summary articles. This section is all about the scientific evidence rather than someone else’s opinion of the evidence. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a review of the literature. This is a synthesis rather than a study by study review. Address the similarities, differences, and controversies in the body of evidence.
2. Analyze and apply knowledge directly to your PICOT- The studies that you cite in this section must relate directly to your PICOT question.
3. Provide precise body of evidence for your Practice Change
4. Discuss objectives for your practice change
5. Discuss where the problem exists, why it exists, what is the preposition for change
6. Apply all that is relevant to the problem. For example: Pros vs Cons, current state of problem
NOTE: It should not reflect your opinion, but rather Evidence Based Practice should be applied
-After completing a literature search on interventions addressing your chosen health problem, write a review that evaluates the strengths and weaknesses of all the sources you have found.
-Use appropriate APA 7th Ed. format along with Syllabus outline
-Scholarly, peer-reviewed, and research articles cited should be within the last five years.
-This section should be 4 pages long (not including the title and reference page).
-Use proper in-text citations with a properly formatted reference list.
-All papers must be written in the 3rd person.
PLEASE ADD -How will you identify the depressed patients without comprising health records? What would you do if a resident presents with depressive symptoms? Keep in mind that the APNs will not be able to treat. In the Review of Literature, you will have to expand on cost of care, what does the data show? How much?
Reminder, each assignment needs a Conclusion paragraph as per APA.
DUE DATE: JULY 24, 2025
PLEASE NOTE CAPSTONE PART 1 IS ATTACHED, READ IT TO DO PART 2 ACCORDINGLY.
PLEASE CAREFULLY READ EACH REQUIREMENT NEEDED FOR THIS CAPSTONE PART 2
1
Capstone Part I PICOT Assignment
Student's name: William Carrazana
Instructor: Carmen Lazo
Course: MSN Capstone Project-DBX-DL01
Date: July 6, 2025
Reducing Depression in Long-Term Care Older Adults Using Group-Based CBT
Depression is a prominent mental disorder among elderly individuals who live in long-term care facilities (LTCFs). The group suffers from higher levels of depression brought about by problems such as isolation, sickness, loss of autonomy, and displacement from loved ones. According to Poole et al. (2022), a quarter of the older residents in LTCFs suffer from severe symptoms of depression. Notwithstanding this, such patients remain under-diagnosed or under-treated. LTCF depression has been associated with poorer health consequences, increased mortality, poor quality of life, and increased costs of care through increased hospitalization and medication expenses (Poole et al., 2022).
This article proposes an evidence-based intervention of guided group-based Cognitive Behavior Therapy (CBT) in order to reduce depressive symptoms and improve mood in LTCF residents. This can be measured by changes in depressive symptom scores on the Geriatric Depression Scale (GDS) upon admission and follow-up after a 12-week intervention. The proposal aligns with nurse-led models of care and offers a choice over pharmacological interventions, thereby providing an affordable approach for LTCFs.
Comprehensive PICOT Analysis
P (Population): Older persons over 65 years with depression who live in LTCFs with depression symptoms. They are usually diagnosed with mild and moderate depression or screened using standardized assessment tools such as the GDS.
I (Intervention): Formulated group-focused CBT, two times a week. The therapy is designed to help participants overcome negative thought patterns and foster positive social interactions.
C (Comparison): Social activities of daily living, like bingo playing, movie evenings, or uncompensated group free-time visits, not therapeutic intervention or mental health counseling.
O (Outcome): Reduction in depressive symptoms and enhanced mood as measured by pre- and post-treatment GDS scores.
T (Time): A 12-week intervention period with sufficient time for involvement and perceptible outcomes.
PICOT question: “In older adults residing in long-term care facilities with symptoms of depression (P), does participation in structured group-based cognitive-behavioral therapy (CBT) sessions (I), compared to routine social activities alone (C), reduce depressive symptoms and improve mood (O) over 12 weeks (T)?
Description of the Vulnerable Population
Older adults in LTCFs are significantly at risk due to some social determinants of health. They include financial constraint, mobility problems, cognitive decline, compromised access to good-quality mental health care, and loneliness. Studies have established that isolation is the best predictor of depression among older individuals (Li, Bai, & Chen, 2022).
Risk indicators for depression among this group are recent bereavement of a spouse, co-morbid chronic diseases, absence of family engagement, and the institution itself. Up to 50% of residents in LTCFs have substantial depressive symptoms, yet most receive no evidence-based treatments (Matos Queirós et al., 2021).
The additive effects of ageism, mental illness stigma, and inadequate staffing in mental health in LTCFs render this group susceptible (Al-Dwaikat et al., 2022). Such vulnerabilities necessitate the use of existing and effective interventions like CBT that are not dependent on psychiatric referral.
Evidence-Based Research Supporting the Intervention
Several recent peer-reviewed reviews support the application of CBT as an effective depression treatment among the elderly. Mijnster et al. (2022) carried out a randomized controlled trial, observing that LTCF residents undergoing group-based CBT reported fewer signs of depression compared to a control group undertaking standard social activities.
Chen et al. (2020) demonstrated the effectiveness of nurse practitioner-delivered CBT, resulting in improved depression scores and increased social interaction. The results highlight that not only is CBT effective, but it can also be implemented when provided by competent, advanced practice nurses within long-term care.
Proposed Intervention
This proposal sets forth the implementation of a 12-week group-based evidence-based CBT intervention among LTCF residents experiencing depressive symptoms. The intervention would last 45 minutes, twice a week, and be delivered by an advanced practice nurse (APN) or a licensed clinical psychologist with training in CBT principles.
Each session will include:
A brief mood check-in
Discussion of cognitive distortions
Behavioral activation exercises
Group interaction to foster social support
Resources required include a private meeting space, printed CBT materials, training sessions for APNs, and standardized evaluation tools like the GDS.
Timeline:
Weeks 1–2: Staff training and participant recruitment/screening
Weeks 3–14: CBT sessions begin (24 sessions total)
Week 15: Post-intervention data collection
Week 16: Program evaluation and feedback
Theoretical Framework: Jean Watson’s Theory of Human Caring
This theory encompasses both the psychological and emotional aspects of healing and is therefore highly applicable to the mental health care of the elderly.
Watson's transpersonal caring theory is best applied in transpersonal caring relationships, which are particularly critical in CBT groups, where empathy, trust, and respect among group members are essential for successful therapy. This is consistent with the process of CBT, which promotes cognitive restructuring and emotional security through positive interpersonal contact.
Using Watson's framework ensures that this intervention is both clinically and humanistically oriented, addressing the emotional and spiritual well-being of residents. Some of the benefits that accrue from this are decreased readmissions, improved emotional resilience, and enhanced quality of life, all of which positively impact health outcomes and cost-effectiveness.
References
Al-Dwaikat, T. N., Rababa, M., & Alaloul, F. (2022). Relationship of stigmatization and social support with depression and anxiety among cognitively intact older adults. Heliyon, 8(9), e10722. https://doi.org/10.1016/j.heliyon.2022.e10722
Chen, J. T.-H., Wuthrich, V. M., Rapee, R. M., Draper, B., Brodaty, H., Cutler, H., Low, L.-F., Georgiou, A., Johnco, C., Jones, M., Meuldijk, D., & Partington, A. (2022). Improving mental health and social participation outcomes in older adults with depression and anxiety: Study protocol for a randomised controlled trial. PLOS ONE, 17(6), e0269981. https://doi.org/10.1371/journal.pone.0269981
Li, Y., Bai, X., & Chen, H. (2022). Social Isolation, Cognitive Function, and Depression Among Chinese Older Adults: Examining Internet Use as a Predictor and a Moderator. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.809713
Matos Queirós, A., von Gunten, A., Martins, M., Wellens, Nathalie I. H., & Verloo, H. (2021). The Forgotten Psychopathology of Depressed Long-Term Care Facility Residents: A Call for Evidence-Based Practice. Dementia and Geriatric Cognitive Disorders Extra, 11(1), 38–44. https://doi.org/10.1159/000514118
Poole, L., Frost, R., Rowlands, H., & Black, G. (2022). Experience of depression in older adults with and without a physical long-term condition: findings from a qualitative interview study. BMJ Open, 12(2), e056566. https://doi.org/10.1136/bmjopen-2021-056566
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