The Application of NICE Guideline Recommendations


Final Paper: Research Proposal

Design a research study on the topic of the study selected in Week One and critiqued in Week Three. Your design should seek to resolve the limitations you identified in the study you critiqued. Your paper must address all of the components required in the “Methods” section of a research proposal:

  • State the research question and/or hypothesis.
  • Specify the approach (qualitative or quantitative), research design, sampling strategy, data collection procedures, and data analysis techniques to be used.
  • If the design is quantitative, also describe the variables, measures, and statistical tests you would use.
  • Analyze ethical issues that may arise and explain how you would handle these issues.


The Application of NICE Guideline Recommendations


This paper will provide readers with a quantitative research design aimed at resolving the limitations emerging from the study by Hetrick, Simmons, Thompson & Parker (2011). This study attempts to identify the potential barriers that may hinder clinicians from employing evidence-based guidelines in tackling youth depression in provision of tertiary specialist mental health service facilities. The researchers also attempt to identify the reasons or experiences that led clinicians to disregard implementing the currently existing guideline recommendations. A major limitation evident in the study by Hetrick, Simmons, Thompson & Parker (2011) is the lack of clarity about the best treatment method for young individuals suffering from severe and complex depressive disorders. The authors note that controversy persists on the best treatment approach and thus the need for further research in the area. This quantitative research design will aim at providing clear details to the following research question: what is the best treatment approach for clinicians in young people suffering from severe and complex depressive disorders?

Literature Review

Al-Harbi (2012) conducted a literature review on effective ways of managing treatment-resistant depression among individuals. The research indicated that about 30 percent of individuals suffering from severe depression do not respond to medications especially the antidepressant treatment process. The research attempts to identify alternative ways of helping such individuals live normal lives once again. The results indicate that application of integrated therapeutic strategies in the treatment of severe depression can be effective especially among young people. Hofmann et al. (2012) explores the effectiveness of the cognitive behavioral therapy in the treatment of various stress-related ailments, including severe depressive condition. The researchers conduct a meta-analysis of studies that examine the concept of cognitive behavioral therapy. A total of 106 studies were selected from an initial sample of 269 meta-analytic studies. This study gives critical information relating to the efficacy of cognitive behavioral therapy in treatment of various mental health issues.

Blumenthal, Smith, & Hoffman (2012) examined the impact of exercise as a therapeutic approach to treatment of depression. The researchers concur that traditional treatment methods such as use of antidepressant medications and psychotherapy may fail in treatment of severe depression, and thus the need to establish alternative and effective approaches. The trio suggests aerobic exercise as an effective alternative approach in the management of severe depressive condition among young people. The researchers conduct randomized controlled trials to assess the effectiveness of aerobic exercise over other conventional methods such as use of antidepressant medications.



As earlier mentioned, this study will take a quantitative approach that will be non-experimental. A quasi-experimental research will be conducted during the study. The quasi-experimental approach will be used to measure as opposed to manipulating the independent variable. The results made in the previous study indicate that clinicians are usually skeptical in adhering to the guideline recommendations outlined by the National Institute for Health and Care Excellence (NICE) in treating young people diagnosed with depressive disorders. A fixed-format questionnaire will be used to test the null hypothesis. As such, the fixed-format questionnaire will test whether clinicians should always follow the outlined guidelines or reject the null hypothesis relating to the conformance with outlined guidelines. Rejection of the null hypothesis will mean that the results support the study outcomes by Hetrick, Simmons, Thompson & Parker (2011). The results will also signal the need to develop clear and systematic guideline recommendations that can help clinicians to effectively manage depression among young individuals.

This qualitative study will be based on a social constructionist perspective or angle. According to Andrews (2012), social constructionism is hedged on the idea that each individual in the world creates or assimilates multiple world experiences through his or her social lens. From the research critique, it is clear that the researchers attempted to identify if any of the participants had any experiences or evidence. This led to the idea that the guideline recommendations made in relation to the NICE were inappropriate, and thus should not have been followed.


The proposed quantitative study will include ‘clinicians’ involved in treatment of depressive problems in young persons as the primary respondents. There exists different opinions among clinicians as to the best treatment approach to use in managing severe depressive disorder. Additionally, there exist conflict views on how drugs should be administered to those suffering from depression. There are multiple rules that guide clinicians on how they are supposed to administer medication to patients which depends on the nature or level of the mental health disorder the patient is suffering from.

The term ‘clinicians’ will be used in this study to refer to focus groups that are made up of nurses, psychiatrists, psychologists, psychotherapists, social health workers, and among other allied health workers. All of these categories will generally be referred to as ‘clinicians’ during the course of the study. Each of the focus groups will be assigned a unique name. The focus groups will be made of clinicians from different categories. The study by Hetrick, Simmons, Thompson, and Parker (2011) utilized a large sample size which increased generalizability of the study results. This study will also aim at attaining a large sample size so as to improve the accuracy of what it measures. According to Balakrishnan, Voinov, & Nikulin, (2013), it is important to use a control group in order to test if there is replicability of study results. This may involve using a different sample of clinicians or the control group to see whether the results will be the same in both experiments.


The study by Hetrick, Simmons, Thompson, and Parker (2011) was centered on the clinicians’ encounters and the thinking behind the clinicians not actualizing the NICE rule proposals. The new theory or examination inquiry can thus be written as: Young individuals are usually given medications only when entering the primary care which renders the NICE rule suggestions insignificant in the clinical practice. The new study proposal suggests that more data will be picked up by likewise considering the effect of not taking after the NICE rule suggestions on patients’ results. Previous patients will be selected to take part in the close ended quantitative research design. The main challenge will be the absence of capacity to test the individuals who were already determined to have extreme depressive problems in the event that they are as yet experiencing this condition. By allowing former patients to do self-reporting of their experiences and including a self-reporting measure, there would be an extra bolster added to this subjective study. By utilizing these uniting operations, the two studies will permit enable the research question under review to be investigated utilizing distinctive exploration outlines and diverse measures (Balakrishnan, Voinov, & Nikulin, 2013).


Data Analysis

The main data analysis technique which will be utilized as a part of this proposed study is Chi-Squared investigation. Chi-Squared analysis is important in helping analyze relationship between nominal values in a set of data (Balakrishnan, Voinov, & Nikulin, 2013). In using the Chi-Squared analysis in the research, it will be possible to establish whether two variables are related to each other or whether they are independent. The first step will involve coding and organization of the observed data. This will be followed by estimations relating to the normal frequencies, which means what qualities would be normal if half of those given the close-ended questionnaire survey were taking drugs when they came to the tertiary healthcare facility. The number representing the individuals surveyed will thus be determined by whether by the time they arrived at the facility they were on medication. In this case, the null hypothesis may state that those who were medication free were equal in number to those on medication. This should be followed by detailed calculations of the deviations between expected and the observed values. At that point a table of basic estimations of the Chi-Squared circulation would be counterchecked with a specific end goal to examine the outcomes. Utilizing Chi-Squared examination gives an experimenter a chance to figure out if the quality is bigger than what can occur randomly. In case the value is big, this may indicate statistical significance. On the off chance that it is much bigger, it demonstrates factual importance (Balakrishnan, Voinov, & Nikulin, 2013). This indicates that the frequencies are more identified with each other and back the first theory instead of the invalid speculation.

Ethical issues

A number of ethical issues may arise in the course of the study. All participants in the study will freely agreed to participate in the study, without any coercion or use of force. Participants will sign an agreement form indicating their consent or willingness to freely participate in the study. The researchers will provide thorough information to participants concerning the study including the risks involved. This will enable the participants to make informed choices when agreeing to participate in the study. Participants will be briefed on specific procedures to be followed in conducting the surveys. This will help in avoiding any confusion that may arise during the research process. The information obtained from the participants will be put to use as per their wishes or concerns. No information given will be used contrary to what the wishes of the participants.

Confidentiality issues are a major concern in any type of research. The researchers must ensure respondents of privacy especially with regard to the information that they willingly share. Breaching the confidentiality aspect may jeopardize the relationships of the clinicians or their career altogether. Confidentiality will be maintained by use of pseudo names to represent the different clinicians who will take place in the research study. This will enable the respondents to hide the real identity of the participants. Ethical issues may arise during the course of the research. For instance, the respondents may sustain physical injuries during the survey period. The researchers must ensure that respondents are not harmed by employing safe and proven research strategies that do not pose any risk to the participants.

In order to satisfy the standards and procedures outlined in regard to the mental health docket, approval must be sought from relevant bodies. In relation to this, approval will be sought from any of the mental health institutes in the country. The study should also meet the requirements of the Institutional Review Board. Ethical concerns may arise due to the fact that the study may involve minors. Due to this fact, disclosure must be made to parents and guardians requesting them to allow their children to participate in the study. This will only apply for participants who are below 18 years of age. Parents or guardians must be consulted in such a scenario since it is assumed that minors may not make rational decisions in deciding whether or not to participate in such a study.

Since the study will involve minors, disclosure of information about the actual details of the study should be made to both the parents or guardians and the minor participants as well. There could also be moral issues about the proposed close-ended survey because of the ages of a bit of the proposed respondents. Since they are minors, revelation of data about the way of the study ought to be made to both the member and their guardian/guardians. Ethical concerns also relate to the type of close-ended questions that the researchers can pose. The researchers should pose questions that are relevant and easy to understand. Questions bearing scientific phrases should be avoided to ensure that minors read and understand everything before answering them.

Lastly, researchers should not alter the information provided by the participants for personal gains or interests. The researchers must use the information as given to them by respondents. Once they acquire the data, the researchers will subject it to scientific tests to evaluate the relatedness or establish patterns of data. The study will be subject to approval by an independent review boar comprising of experts. The review board will assessing everything from the procedures followed to maintenance of ethical standards in conducting the study.


There were different results and data which originated from the foundational study. In utilizing the proposed close-ended format questionnaire to get robust data, the research will be able to determine the hypothesis. On the greater part of the four key NICE rule proposals, there were numerous clinicians who showed they don’t actualize the suggestions for different reasons a key reason provided in the foundation research is that the patients were already on antidepressant medications. The need to develop unique treatment procedures from the recommended guidelines was based on health facility experience and the determination that the rule suggestions simply don’t fit circumstances that oftentimes happen in the genuine treatment setting. In comparing the results of both the studies, a researcher will be able to make the critical decision on whether the NICE guideline recommendations are important consideration in the treatment approaches or not.

The investigations performed by utilizing Chi-Squared results will be effective in helping the researchers know whether the act of patients arriving at the facility while already on antidepressant medications renders in any way the guideline recommendations irrelevant. The foundations research findings indicate that guideline recommendations were not being observed since majority of clinicians held the belief that they are irrelevant to the treatment of depression especially among the young individuals. This study will be effective since it will enable researchers outline the major reasons why clinicians opt to use other methods in treatment of depression to those outlined by NICE.

This study underpins the explanations made by clinicians that the rule suggestions may not be appropriate for every patient who presents at a tertiary psychological wellness office. This foundational study results proposed an unmistakable requirement for further research to figure out if or not there are weaknesses inside the rule suggestions which lead clinicians to pick other treatment arranges. The blended techniques study being proposed in this new research would be a strong device.


Al-Harbi, K. S. (2012). Treatment-resistant depression: therapeutic trends, challenges, and future directions. Retrieved from

Andrews, T. (2012). What is social constructionism? Grounded Theory Review: An International Journal. Retrieved on August 15, 2014 from

Balakrishnan, N., Voinov, V., & Nikulin, M. S. (2013). Chi-Squared Goodness of Fit Tests with Applications. Burlington: Elsevier Science.

Blumenthal, J. A., Smith, P. J., & Hoffman, B. M. (2012). Is exercise a viable treatment for depression? ACSMs Fitness Journal, 16(4): 14-21 doi 10.1249/01.FIT.0000416000.09526.eb

Hetrick, S. E., Simmons, M., Thompson, A., & Parker, A. G. (2011). What are specialist mental health clinician attitudes to guideline recommendations for the treatment of depression in young people? Australian and New Zealand Journal of Psychiatry, 45, 993-1001. Retrieved on August 1, 2014 from EBSCOhost.

Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analysis. Cognitive Therapy Research, 36(5): 427-440