s there a difference between “common practice” and “best practice”?

When you first went to work for your current organization, experienced colleagues may have shared with you details about processes and procedures. Perhaps you even attended an orientation session to brief you on these matters. As a “rookie,” you likely kept the nature of your questions to those with answers that would best help you perform your new role.

Over time and with experience, perhaps you recognized aspects of these processes and procedures that you wanted to question further. This is the realm of clinical inquiry.

Clinical inquiry is the practice of asking questions about clinical practice. To continuously improve patient care, all nurses should consistently use clinical inquiry to question why they are doing something the way they are doing it. Do they know why it is done this way, or is it just because we have always done it this way? Is it a common practice or a best practice?

In this Assignment, you will identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed.

To Prepare:

  • Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry. Keep in mind that the clinical issue you identify for your research will stay the same for the entire course. 
  • Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
  • Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.
  • Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.

Part 1: Identifying Research Methodologies

After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:

  • The full citation of each peer-reviewed article in APA format.
  • A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.
  • A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.
  • A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.
  • A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.


Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness.


Hirshbein, Laura D.


Journal of the History of the Behavioral Sciences Spring2010; Vol. 46 (2).



Journal Info:

Publisher: Wiley-Blackwell ISSN: 0022-5061

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History, power, and electricity: American popular magazine accounts of electroconvulsive therapy, 1940–2005.


Hirshbein, Laura1 [email protected]

Sarvananda, Sharmalie2


Journal of the History of the Behavioral Sciences. Winter2008, Vol. 44 Issue 1, p1-18. 18p.

Document Type:


Subject Terms:


*PSYCHIATRIC treatment


*SHOCK therapy

Geographic Terms:



Electroconvulsive therapy (ECT) is a psychiatric treatment that has been in use in the United States since the 1940s. During the whole of its existence, it has been extensively discussed and debated within American popular magazines. While initial reports of the treatment highlighted its benefits to patients, accounts by the 1970s and 1980s were increasingly polarized. This article analyzes the popular accounts over time, particularly the ways in which the debates over ECT have revolved around different interpretations of ECT’s history and its power dynamics. © 2008Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

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Author Affiliations:

1Assistant Professor of Psychiatry, University of Michigan

2University of Michigan





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Journal of the History of the Behavioral Sciences, Vol. 46(2), 208–209 Spring 2010
Published online in Wiley Interscience (www.interscience.wiley.com). DOI 10.1002/jhbs.20426
© 2010 Wiley Periodicals, Inc.


Benjamin Reiss. Theaters of Madness: Insane Asylums and Nineteenth-Century American
Culture. Chicago, IL: University of Chicago Press, 2008. xi � 237 pp. $50 (cloth).
ISBN-13: 978-0-226-70963-5.

Benjamin Reiss’s Theaters of Madness is a fascinating attempt to enliven and deepen the
literature on cultural definitions of madness and their implications for democratic institutions.
A literary scholar with historical sensibilities, Reiss offers readings of a wide variety of
“texts” to add irony and nuance to our understanding of what he views as a central problem
for nineteenth-century Americans: the involuntary restraint of those deemed mentally inca-
pable of responsibly exercising personal liberty. He demonstrates from the outset that the
issue resonated beyond legal and medical circles to the broader cultural horizon. Politicians,
reformers, and creative artists grappled with the challenge of insanity to republican institu-
tions and focused on the asylum as the embodiment of their hopes and fears. Reiss presents
brief insightful commentary on major scholarly views of the asylum movement and attempts
to penetrate the consciousness of incarcerated citizens even as he assesses the meaning of asy-
lum reform in its own time and for the present.

Theaters of Madness gives us neither a comprehensive historical reconsideration nor a
thoroughgoing revision of Erving Goffman or Michel Foucault. Rather, Reiss uses a kaleido-
scopic approach that mines forgotten details of asylum history and offers new readings of
classic texts. He brings together six essay-length chapters engaging “cultural life in the
nineteenth-century asylum and asylum life in nineteenth-century culture” in the cause of
“recording the dialectical tension between the institutional processing of culture and the cul-
tural processing of the institution” (p. 17).

These “snapshots,” as Reiss calls his individual explorations, remind one of the occa-
sional motion picture that seeks the soul of a city or the essence of an emotion by collecting
short subjects around its theme, but instead of Paris or Love the focus is the asylum. Three
pieces look at aspects of life inside the walls and three take the view from without. Woven
into all six chapters are considerations of race, creativity, gender, power, and the paradoxical
responses of republican society as it sought a means to control personal behavior it deemed a
threat to personal liberty. Reiss makes no claim for “thoroughness or even representativeness”
and describes some of his cases as “transparently exceptional, strange, or offbeat.” Instead, he
notes, he followed his nose in seeking subjects that illustrated “individuals caught up


Effects of electroconvulsive therapy in the systemic
inflammatory balance of patients with severe mental disorder

Miquel Bioque, MD, PhD,1,2,3,4† Karina S. Mac-Dowell, MSc, PhD,3,5† Ana Meseguer, RN,1,3 Elisabet Macau, RN,6

Ricard Valero, MD, PhD,7,8 Eduard Vieta, MD, PhD,2,3,4,9 Juan C. Leza, MD, PhD3,5* and
Miquel Bernardo, MD, PhD 1,2,3,4*

Aim: There is a great interest in the role of the immune sys-
tem and the inflammatory balance as key mechanisms
involved in the pathophysiology of severe mental disorders.
Previous studies have indicated that electroconvulsive ther-
apy (ECT) produces changes in certain inflammatory media-
tors or in the immune system response. This study aimed to
explore the effects of ECT on the nuclear transcription factor
κB (NFκB) pathway, a main regulatory pathway of the
inflammatory/immune response.

Methods: Thirty subjects with a severe mental disorder
receiving treatment with ECT in our center were included.
Thirteen systemic biomarkers related to the NFκB pathway
were analyzed right before and 2 h after a single ECT session.

Results: An ECT session significantly decreased the
expression of NFκB (P = 0.035) and of the inducible nitric
oxide synthase (P = 0.012), and the plasma levels of nitrites
(P = 0.027), prostaglandin E2 (P = 0.049), and 15-deoxy-
PGJ2 (P < 0.001). Decrease in plasmatic levels of nitrites was

greater in females than in males (P = 0.021). A positive corre-
lation between the ECT stimulus load and changes in the
expression of NFkB was found (P = 0.036). Thiobarbituric
acid reactive substance levels were decreased in treatment
responders and increased in non-responders (P = 0.047).

Conclusion: Our study shows the effects that a single ses-
sion of ECT produces on a canonical regulatory pathway of
the inflammatory/innate immune system and the inflamma-
tory balance. These biomarkers could be useful as treatment
response targets and could help to clarify the biological
basis of ECT action. These findings warrant greater attention
in future investigations and in the translational significance
of these data.

Keywords: biomarkers, ECT, electroconvulsive therapy, immune

system, inflammation.


Electroconvulsive therapy (ECT) is considered an effective and safe
treatment for patients with a severe mental disorder, being used
mainly in certain cases of major depression, bipolar disorder (BD),
and schizophrenia-related disorders resistant to pharmacological
treatments.1–5 Despite the extensive clinical experience accumulated
with this technique and all the scientific knowledge acquired about its
mechanisms of action at the molecular level, this field of knowledge
requires more research on its biological basis to better understand its
mechanistic basis and in order to help clinicians in decision-m

[Mental Illness 2017; 9:7181] [page 63]

Adverse effects of electrocon-
vulsive therapy on cognitive
Sasha S. Getty,1 Lawrence R. Faziola2
1University of California at Irvine,
School of Medicine; 2Department of
Psychiatry and Human Behavior,
University of California, Irvine Medical
Center, CA, USA

Electroconvulsive therapy (ECT) has his-
torically been shown to be a highly effective
method of treating major depression and
catatonic state otherwise resistant to psy-
chopharmacotherapy.1-5 However, ECT has
also been associated with a variety of tran-
sient impairments in cognitive performance
during and following the treatment.6-10 The
side effects, often subjectively reported by
the patients, include deficits in orientation,
short term memory function, attention,
speech fluency, and executive functions
lasting from hours to perhaps months in a
number of cases.6-10 These reported attrib-
utes often lead to limited use of ECT as an
acute treatment of treatment-resistant
depression and other conditions where it
can potentially produce positive overturn-
ing effects. There appears to be a lack of
clarity and consensus in the literature
regarding ECT-related adverse effects on
cognitive performance. While some studies
have reported absence of any effects on
memory and implicit learning,6 several oth-
ers have shown diverse negative impacts
across various domains of cognition includ-
ing greatest global decline associated with
bitemporal ECT, major deterioration of ver-
bal memory attributed to bifrontal ECT, and
largest decline in visual memory related to
right unilateral ECT, as measured by tests
such as Mini Mental State exam,7 Trail-
Making,11,12 Rey Auditory Verbal
Learning,11,12 autobiographical memory,
visual memory, and verbal fluency.11,13
Therefore, this topic remains much debat-
able, and can still benefit from investiga-
tions that would add to the body of evidence
to further elucidate and clarify different
aspects and extent of these adverse effects
in terms of factors such as distinction
between immediate versus delayed impacts,
different electrode placement methods and
dosing, as well as the appropriate measure-
ment methods sensitive to particular cogni-
tive domains.

Authors of this study14 investigated the
potential immediate short-term adverse
effect of right unilateral ECT on cognitive
function using digital ascending number
tapping test (DANTT) as a novel psycho-

metric measurement modality. Using
DANNT, the authors specifically studied
speed of processing, executive function,
and visual search before and after treatment
in patients of both genders between the ages
of 36 to 76 years. They concluded that ECT
does not significantly alter cognitive per-
formance in those domains up to 2 hours
after receiving therapy, which is in stark



Electroconvulsive therapy (ECT) is a psychiatric treatment that has been in use in the
United States since the 1940s. During the whole of its existence, it has been extensively
discussed and debated within American popular magazines. While initial reports of the
treatment highlighted its benefits to patients, accounts by the 1970s and 1980s were
increasingly polarized. This article analyzes the popular accounts over time, particularly
the ways in which the debates over ECT have revolved around different interpretations of
ECT’s history and its power dynamics. © 2008 Wiley Periodicals, Inc.

On June 25, 2005, NBC aired a Today Show interview of actor Tom Cruise during which
Cruise took to task fellow actor Brooke Shields about her decision to take antidepressant
medication. His remarks centered not on medication, though, but rather on the psychiatric
enterprise as a whole, including electroconvulsive therapy:

I’ve never agreed with psychiatry, ever. Before I was a Scientologist I never agreed with
psychiatry. And when I started studying the history of psychiatry, I understood more and
more why I didn’t believe in psychology. . . . Here we are today, where I talk out against
drugs and psychiatric abuses of electric shocking people, okay, against their will, of
drugging children with them not knowing the effects of these drugs. . . . You don’t know
the history of psychiatry. I do. (Lauer, 2005)

Cruise’s avowed stance as a member of the Church of Scientology, a group that has been
aggressively opposed to psychiatry in the last few decades, certainly explains the vehemence
with which he attacked psychiatry. Yet he was not content to merely attack current psychiatric
practice or even just medications. Instead, he invoked the evidence of history to demonstrate
the problems with psychiatry, including electroconvulsive therapy.1

In 1940, the first descriptions of new treatments for mental illness appeared in the pop-
ular press in the United States: convulsive therapies or shock treatments. Magazine accounts
of the time enthusiastically reported the benefits of shock for a hopeless patient population.

Journal of the History of the Behavioral Sciences, Vol. 44(1), 1–18 Winter 2008
Published online in Wiley Interscience (www.interscience.wiley.com). DOI 10.1002/jhbs.20283
© 2008 Wiley Periodicals, Inc.


LAURA HIRSHBEIN, MD, PhD, is Assistant Professor of Psychiatry at the University of Michigan.
Dr. Hirshbein completed her MD and residency training in psychiatry at the University of Michigan, and re-
ceived her PhD in the history of medicine from the Johns Hopkins University. She is completing a book on the
history of depression in the twentieth century, American Melancholy: A History of Depressio