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¶ … Music Therapy on Depression Name Course Professor Date Part II Nursing Diagnosis: Ineffective coping with psychiatric symptoms exacerbates difficulties brought by a mental health disorder. The ineffective coping strategies are evidenced in poor concentration, low self-esteem, and poor self-care. Population: The population of interest is outpatients suffering from depression. Intervention: Provide opportunities for patients to listening to music to help alleviate or deal with symptoms of this psychiatric disorder. Comparison and Contrast: Does music therapy contribute to less depressive symptoms? How effective is music therapy in helping patients develop suitable coping strategies for depression. Outcome: Improved quality of life including lessened depression levels and improved capabilities to cope with psychiatric symptoms through listening to music. Clinical Question: Is listening to music effective in lessening psychiatric symptoms in depressive patients receiving music therapy? The purpose of this assignment is to explore the effectiveness of using music as an intervention for depressive symptoms and improved quality of life based on existing evidence-based practice. Narrative Discussion In Chan et al. (2012), the objective of the study was to determine the impact of music on the levels of depression in older adults. To achieve this objective, the researchers conducted a randomized controlled study on 50 older adults who listened to their preferred music at home for 30 minutes weekly for eight weeks. The depression scores that were collected once per week demonstrated that the levels of depression reduced every week among participants in the music group as compared to a non-music group that was subjected to control during the same period. Atiwannapat et al. (2016) carried out a research to explore the impacts of, "active group music therapy and receptive group music therapy to counseling in treatment of major depressive disorder" (p.141). The researchers randomly identified and assigned 14 major depressive disorder outpatients to active music therapy, receptive group music therapy, and group counseling. After assessing participants at baseline, they found that receptive group music therapy is characterized by faster achievement of peak therapeutic effect whereas active group music therapy has higher peak impact. Discussion There were some similarities and differences in both studies that can impact how music therapy is recommended as an intervention for reducing the levels of depression. First, these studies concur that music therapy is a non-pharmacological intervention that can help in management of depression among outpatients. Based on these studies, music therapy is considered because of pharmacological treatment measures are usually associated with adverse impacts and sometimes ineffective. Secondly, the studies involve a randomized controlled trial, which is a true experiment. This research design helps in enhancing the probability that study findings are not due to chance. Given the use of randomized controlled trial for these studies, their findings relatively represent the actual impact of music on outpatient settings. Third, both researches were carried out in outpatient settings and on a weekly basis, which was suitable in determining how the intervention impacted depression patients. Fourth, both studies grouped their participants in different categories i.e. one in which the intervention was used and another control group that was not subjected to the intervention. Chan et al. (2012) conducted the trial in the participant's home where a research nurse visited on a weekly basis to gather depression scores for eight weeks as data was collected between July 2009 and June 2010. The study also utilized a one-tailed repeated measure of assessing covariance i.e. RM ANCOVA to examine effects while a medium effect was selected based on findings from the previous study. Four different categories of music i.e. Malay, Western, Chinese, and Indian were first introduced to the subjects. For data analysis, Chan et al. (2012) utilized descriptive statistics to define the characteristics of the group while chi-square test was used to test homogeneity between groups. Unlike Chan et al. (2012), Atiwannapat et al. (2016) divided their participants into three groups and conducted the study as part of group therapy for outpatients with depression. Participants in this study not only listened to music but also sang and played musical instruments. This study also involved lyric analysis, song writing, and drawing the music by the subjects, which was different from the other study. Therefore, Atiwannapat et al. (2016) explored different aspects relating to music rather than simply listening to music like in the other study. For data analysis, this research utilized statistical analyses including STATA version 13, Kruskal-Wallis tests, and Fisher's exact test. While Chan et al. (2012) conducted the study on older patients aged 55 years or more, Atiwannapat et al. (2016) carried out the research on participants aged between 16 and 65 years. Therefore, the results of the study were difficult to compare because of the differences in age group and the fact that they were completed over different time periods. However, both articles provide significant evidence to demonstrate that music therapy helps in lessening the levels of depression among outpatients. Using Newhouse Level of Evidence, these studies contained weaknesses that need to be addressed as shown in the Appendix. Chan et al. (2012) received a rating of I-B good because of its fairly definitive conclusions that are consistent with an adequate number of well defined studies (Newhouse, 2006). Atiwannapat et al. (2016) obtained a Newhouse score of I-B good because of insufficient sample size but reasonably consistent results and use of reliable and valid research methodology. Part III The patient is 40- to 50-year-old married female a with essentially no psychiatric history presented to the emergency department with her husband due to significant mood lability, feeling a lot of anger towards others and having thoughts of wanting to hurt people over a couple months, but have gotten worse over the last two weeks. She reported that she has been feeling agitated, tensed, and has irritable edge. Thoughts are racing, concentration is poor, feeling more impulsive -- have been hitting wall and kicking a copier machine. She has no psychosis, but has longstanding issues with irritability and anger. Patient denied any previous episodes of depression and agitation. Her symptoms cause interpersonal, employment and familial difficulties. Patient is danger to self and others. She is too impulsive and aggressive to manage outside structured milieu. Despite having no psychiatric history, the 40- to 50-year-old patient is probably suffering from depression since she's showing symptoms of this disorder. She needs an intervention that will help her manage anger and irritation, improve concentration, and avoid tension. These factors have seemingly played a major role in her relationship, family, and employment problems. As evidenced in the two studies, listening to music will be a suitable non-pharmacological intervention to deal with the patient's condition. This is a suitable intervention because the patient has no history of depression and agitation. Music therapy will help improve the patient's condition by giving her other outlets for relieving stress and anxiety, developing safe and appropriate behaviors, and lessening depressive symptoms (Thoma et al., 2013). Final Reflection As a mental health nurse, my work has involved playing different roles that assist patients to control/manage their conditions. I have been involved in maintaining contacts with patients in relation to their health and well being and conducting assessments with regards to management of the patient's condition vis-a-vis the clinical intervention. During this process, I have been involved in ensuring the patient adheres to medication and other intervention measures to effective control and manage his/her condition. Apart from patient interaction and assessment, I have also been involved in care planning and evaluation of evidence of clinical intervention. This has entailed working with physicians to coordinate care processes and conducting research on clinical interventions that are suitable for specific conditions in order to improve care and patient outcomes. This experience has helped me realize that the role of mental health nurse entails carrying out different activities towards delivery of patient care. In this case, mental health nurses not only act as supportive staff to physicians but also carry out other tasks to help improve the health and well-being of patients. This has in turn changed my understanding of the roles and responsibilities of mental health nurses. These practitioners act as the link between the patient and the health care team and coordinating patient care strategies and processes. Moreover, I have realized that planning evidence-based care involves conducting research on evidence-based practices and using them as the benchmark for coordinating and providing care. These experiences have contributed to my growth and development as a nurse by enabling me to understand the role of a nurse and how to use evidence-based practices to plan and coordinate care. In essence, these experiences have been crucial in helping me gain real-world knowledge and skills in nursing. References Atiwannapat et al. (2016, March 26). Active vs. Receptive Group Music Therapy for Major Depressive Disorder -- A Pilot Study. Complementary Therapies in Medicine, 26(2016), 141-145. Chan et al. (2012). Effects of Music on Depression in Older People: A Randomized Controlled Trial. Journal of Clinical Nursing, 21, 776-783. Newhouse et al. (2006). JHNEBP Evidence Rating Scales. Retrieved from Vanderbilt University Medical Center website: http://www.mc.vanderbilt.edu/documents/CAPNAH/files/Mentoring/Section%206/JHNEDP%20Evidence%20Rating%20Scale.pdf Thoma et al. (2013). The Effect of Music on the Human Stress Response. Plos One, 8(8). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734071/ Appendix Literature review table (Article I) Author, date Purpose of the study Population and setting, and sample size (n). (For a systematic review indicate the setting and number of studies) Methods (For a systematic review indicate search methods) Findings Implication for practice Strength of the evidence (Level I, II, III)/Quality of the evidence, based on the JHNEBP Evidence Rating Scales (Newhouse, Dearholt, Pugh, & White, 2005) Moon Fai Chan, Zi Yang Wong, Hideaki Onishi and Naidu Vellasamy Thayala, 2011 To explore the effect of music therapy on levels of depression in older adults. The study targeted older adults suffering from depression in the outpatient setting i.e. at home. 52 older adults aged 55 years or more were selected as the sample size for the research. A randomized control trial was carried out using descriptive statistics, chi-square tests, Fisher's exact test, and Shapiro-Wilk test for data analysis. The study found that listening to music helps in lessening the levels of depression in older adults. Music is a therapeutic intervention that can be used to enhance the quality of life of older people with depression. It's an inexpensive, simple and non-invasive treatment option. Since it was a randomized controlled trial, it's rated as I-B good. Appendix Literature review table (Article II) Author, date Purpose of the study Population and setting, and sample size (n)b Methodsc Findings Implication for practice Strength of the evidence (Level I, II, III)/Quality of the evidence, based on the JHNEBP Evidence Rating Scales (Newhouse, Dearholt, Pugh, & White, 2005) Penchaya Atiwannapat, Papan Thaipisuttikul, Patchawan Poopityastaporn and Wanwisa Katekaew, 2016 The purpose of the study was to compare the impact of active and receptive group music therapy to group counseling in MDD treatment. The researchers generally targeted outpatients with depression across all age groups and conducted the study as part of group therapy. A sample size of 14 outpatients aged 18-65 years was selected. The study utilized a randomized controlled trial and statistical analyses for data analysis. They found that group music therapy is a suitable alternative treatment approach for depression, especially Major Depressive Disorder. Group music therapy requires more studies and research in the nursing field in relation to treatment of depression. Since it was a randomized controlled trial, it received a rating score of I-B bad. Johns Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal Chan et al. (2012). Strength of Study Design • Was sample size adequate and appropriate? Yes No • Were study participants randomized? Yes No • Was there an intervention? Yes No • Was there a control group? Yes No • If there was more than one group, were groups equally treated, except for the intervention? Yes No • Was there adequate description of the data collection methods Yes No Study Results • Were results clearly presented? Yes No • Was an interpretation/analysis provided? Yes No Study Conclusions • Were conclusions based on clearly presented results? Yes No • Were study limitations identified and discussed? Yes No Pertinent Study Findings and Recommendations • Will the results help me in caring for my patients? Yes No Johns Hopkins Nursing Evidence-Based Practice Research Evidence Appraisal Atiwannapat et al. (2016) Strength of Study Design • Was sample size adequate and appropriate? Yes No • Were study participants randomized? Yes No • Was there an intervention? Yes No • Was there a control group? Yes No • If there was more than one group, were groups equally treated, except for the intervention? Yes No • Was there adequate description of the data collection methods Yes No Study Results • Were results clearly presented? Yes No • Was an interpretation/analysis provided? Yes No Study Conclusions • Were conclusions based on clearly presented results? Yes No • Were study limitations identified and discussed? Yes No Pertinent Study Findings and Recommendations • Will the results help me in caring for my patients? Yes No