Development and Evaluation of Clinical Practice Guidelines for Psychiatric Nurses: Psychosocial Therapy in Depressive Disorders

Abstract

Psychiatric nurses play a crucial role in the medical field, particularly in caring for patients with depression. The objectives of this research were to develop and study the outcomes of clinical and psychosocial interventions for patients with depression, focusing on psychiatric nurses’ roles. The assessment included measuring the results of depressive symptoms, recurrence rates, hospital readmissions, satisfaction levels, and confidence among mental health nurses. The research and development process was comprised four phases: 1) Development of the guidelines according to the GRADE approach. 2) Trial usage and refinement at Prasrimahabhodi Psychiatric Hospital, involving implementation with 5 psychiatric nurses and 15 depressed patients exhibiting mild or more serious symptoms who were assessed using the 9-item Depression Scale (9Q). 3) Evaluation of the developed guidelines through quasi-experimental research involving 44 depressed patients and 10 psychiatric nurses with similar characteristics to those in phase 2, but who were not participants in the primary trial. Follow-up assessments occured at 2 and 6 months to evaluate satisfaction and confidence related to using the approach among the psychiatric nurses. Data analysis employed frequency percentages, Chi-square tests, and Mann-Whitney U tests. 4) Refinement and implementation of the study results, leading to the development of clinical practice guidelines tailored to   the severity levels of the patients’ symptoms. The study’s outcomes provided strong recommendations and high-quality evidence supporting the use of clinical practices based on the severity of symptom. For mild to moderate symptoms, exercise therapy, problem-solving, psychoeducation, behavioral activation, reminiscence therapy, mindfulness-based cognitive therapy, cognitive behavioral therapy, and self-management are recommended. For moderate to severe symptoms, collaborative care and cognitive-behavioral therapy were recommended, as well as there being strong recommendations with high-quality evidence for both cognitive and behavioral interventions.

The results: The study revealed a significant reduction in depressive symptoms and recurrence rates among the patients the experimental group compared to the control group (p < .05). Nurse satisfaction with and confidence in employing the interventions increased, leading to a decrease in the incidence of hospital readmissions and the number inpatient days.