To what extent can FX43 reduce negative symptoms and promote well-being among clinically depressed adults?

PART 1: Getting Started, Introduction, Research Question and the Literature Search

Okay, so what is the purpose of this assignment? Basically, you need to identify, examine and critique two research studies (one quantitative and one qualitative) from your field of practice. The following video links provide an overview of these two research paradigms:
A short animated clip explaining the basic principles of quantitative and qualitative research approaches: https://www.youtube.com/watch?v=2X-QSU6-hPU
An interesting presentation by Laura Killam discussing quantitative and qualitative research paradigms in nursing: https://www.youtube.com/watch?v=UA0-RMPi7qE
Professor John Creswell talking about quantitative and qualitative research from a mixed-methods perspective: https://www.youtube.com/watch?v=1OaNiTlpyX8

WHERE DO I START?
You might have not yet decided on an area of focus; or you may have several areas of interest, but cannot decide which would be best. With regards to motivation, it is often useful to pick an area you are genuinely interested in. However, you need to choose an area for which there is sufficient research. Motivation for your chosen area can come from various sources. Think about your time on placement; was there anything that you found especially interesting?
Let’s say you’re a student mental health nurse who has had placement working with individuals who experience depression. You might be aware of the side-effects associated with anti-depressant use and wonder whether these drugs are over-prescribed. You might have read about other (less harmful) approaches to treating depression. Therefore, you could choose to examine the effectiveness of newer talking therapies, such as Acceptance and Commitment Therapy (ACT), or mindfulness in treating depression. Alternatively, you may want to examine the effects of herbal medications in alleviating symptoms of depression.
Maybe there is something you have experienced in placement that you want to know more about. If not, you could always conduct a web-search, or look at nursing organisations to see what they are talking about.
To further assist with this assignment guide, a fictitious example will be used. It will involve a herbal alternative for treating depression called FX43. This herbal medication was originally sold as a diet-pill, but failed to have any significant impact on weight loss. However, some users reported that the medication had a positive effect on their mood. As a result, there have been a series of research studies examining the effects of this medication as an anti-depressant. Whilst quantitative research studies (i.e. RCTs) have examined how effective this medication is in reducing symptoms of depression, qualitative studies have explored the experiences of taking the medication and have helped to develop theory as to how it works.

INTRODUCTION: Outline the structure and content of the work. Describe why this topic is important to nursing practice.
You may also briefly describe the structure of the assignment in your introduction. However, don’t just describe a generic structure:
E.g. ‘This assignment will start with a literature search using databases and then critique two pieces of literature in a chosen area….. It will end with a conclusion and reference list.’
Be specific to your area:
E.g. ‘Due to the challenges surrounding anti-depressant use, the current assignment will identify two pieces of research (one qualitative; one quantitative) exploring the effects of FX43 in treating depression. A systematic search will be conducted using three relevant databases (CINAHL, BND and PsycINFO). Both studies will be stringently examined using Polit and Beck’s (2010) critiquing framework. Their strengths, limitations, and contributions to theory and practice will be discussed.
A good introduction will use evidence to emphasise a problem and demonstrate rationale for the exploring the area. So, your rationale might be (again, this is fictitious):
Depression is a growing concern in the UK (Mind, 2015). Increasing numbers of individuals are being prescribed anti-depressant medication to alleviate symptoms and promote well-being (REF). A series of recent research studies have highlighted a range of negative side effects which can be particularly detrimental to patients with depression (e.g. REF; REF; REF). Whilst talking therapies are a valuable alternative to pharmacological interventions, waiting times in the UK can be high (REF). In some instances, this has been particularly detrimental to patients. FX43 is a herbal medication developed to assist with weight loss. A systematic review suggested FX43 was ineffective at controlling weight gain (REF), but tended to increase the mood of participants. This assignment will report a systematic literature search and critically examination of two pieces of research (1 quantitative and 1 qualitative) exploring the effects of FX43 as an antidepressant medication.
LITERATURE SEARCH QUESTION:
To assist with your literature search and selection, it is useful to generate a literature search or clinical question after the introduction. This question is mainly for the literature search section and will help you identify two similar articles for your critique. You could use the PIO or PICO system to help generate a question (see Polit & Beck, 2014). Whilst a PICO question is more suitable for identifying quantitative research articles, a PIO question is more basic and might be more relevant for this assignment, as it more easily accommodates both qualitative and quantitative studies. The PIO components for the hypothetical question for this assignment guide are listed below:
Population: Adults with depression
Intervention: FX43
Outcome: reduce symptoms of depression / promote well-being
Using these criteria, the following question was generated:
To what extent can FX43 reduce negative symptoms and promote well-being among clinically depressed adults?
An alternative approach would be to propose two related questions (one for quantitative and another for quantitative):
How does FX43 compare to Prozac in treating adults diagnosed with depression?
What are the experiences of experiences of individuals taking FX43?

LITERATURE SEARCH:
This section should precisely detail your literature search strategy and the process for selecting your two articles. Ideally, your search should be transparent enough to be replicated by the reader. Try to display your information in a way that shows every step of the process.
Which databases did you use? – Think about why you used these particular databases and justify your choice. We recommend at least two databases that are relevant to your chosen topic area.

What key search terms did you use? – When conducting a search, it is important to consider the most appropriate search terms for your chosen area. For the fictitious example presented above, the following search terms were generated for identifying papers surrounding depression:
‘depression’, ‘depressed’, ‘depressive illness’, ‘unipolar depression’, ‘affective disorder’.
Unlike a Google search, many database search engines only search for the exact word that you type in. Therefore, if you type in ‘depression’, it will identify articles containing the work ‘depression’. It will not identify articles which have used the term ‘depressed’, or ‘depressive’ instead of ‘depression’. This could limit your findings, because some authors may not use ‘depression’ as a term. After all, it is perfectively acceptable to use ‘depressive illness’ or ‘depressed individuals’.
So, does that mean we need to type all of these variations of depression into the search box?
Not necessarily. As we can see, there are three terms here that start with the letters ‘depress’. Therefore, we can use an asterisk symbol (e.g. ) to tell the search engine that we are looking for all terms that start with ‘depress’. Typing ‘depress’ will identify articles that use either ‘depression’, ‘depressive’ and ‘depressed’. It is also useful to put on the end of words where the plural of the word may also be valid for the search. For example: ‘Nurse’ and ‘Nurses’ – to search for both of these, you could type in ‘Nurse’. If you also wanted to search for ‘Nursing’, you could type in ‘Nurs’.
However, you will have noticed that there were some other terms we have not covered with depress* (i.e. ‘affective disorder’). These terms would need to be entered separately. You may consider using the ‘OR’ operator when using different terms. For example:
(depress* OR affective disorder*)

In addition, the AND and NOT operators can also be used. See Polit and Beck for further details on using these. Table 1 on the next page provides an example of how AND and OR were used in this fictitious search.

How many results did this yield?
A great way to show this is by using a table similar to the one below. It shows the number of articles for each search term for three databases. You will see that the search terms were entered progressively and the number of hits were recorder for each search. In addition, two filters were added after the final search which reduced the findings even further. You may choose to add the filters at the start of the search. You would need to specify this.

Table 1:
Quantitative and Qualitative search strategy for the three databases
Search PSYCinfo CINAHL BND
Quantitative
(depress* OR affective disorder) 36, 623 32, 345 1, 023 (depress OR affective disorder) AND FX23 102 89 56 (depress OR affective disorder) AND FX23 AND effective 87 57 42
(depress* OR affective disorder) AND FX23 AND effective AND (trial OR RCT) 23 18 3
Filters: 2010-present 21 16 3
Filters: full-text 9 6 1

Qualitative
(depress* OR affective disorder*)

36, 623

32, 345

1, 023
(depress* OR affective disorder) AND FX23 102 89 56 (depress OR affective disorder) AND FX23 AND (qualitative OR experience) 32 23 14
Filters: 2010-present 30 21 14
Filters: full-text 8 6 4

After this fictitious search, we are left with a total of 34 studies (16 quantitative studies and 18 quantitative studies) when we combine the final search results from the three databases.
How do we choose the two studies that we want?
It is likely that your databases will have identified duplicate results, and many of these will not be appropriate. You may choose to demonstrate how you identified your articles, using a flow diagram. On the following page, there is a 7-step flow chart which show the 34 articles were reduced to one qualitative study and one quantitative study (see Figure 1).
STEP 1 involves totalling all studies from the three databases (or however many you have used).
STEP 2 involves the removal of duplicates (i.e. duplicate studies that were identified in more than one database).
STEP 3 provides the total number of studies after duplicates were removed.
STEP 4 involves the removal of studies after their titles and abstracts were examined. These studies would have likely been deemed as not quite appropriate or relevant to the area of interest.
STEP 5 provides the total number of studies after.
STEP 4 was conducted and less relevant papers were removed.
STEP 6 is a major step, where the remaining papers were examined in depth. Often the hierarchy of evidence is used to assist with this step. It mainly involves reading through the remaining studies and identifying those most relevant to your assignment and chosen area.
STEP 7 reports the two selected studies after the previous steps.

Please note that it is not essential to use a flow diagram in this assignment. If you do use one, it might be more relevant to use in the SELECTION OF LITERATURE section. However, if you do use a flow diagram, make sure it is discussed in the main-body of the assignment. The selection of literature and the critiquing components will be discussed in the Assignment Guide Part 2

Figure 1: Flow diagram showing steps taken in selecting articles