Practice Problem
Petrosyan et al. (2017) report a macro-level issue: they state that the detection of depression is currently not very effective, which they attribute to the fact that the clinical guidelines are rarely followed in practice. For example, a needs assessment at the VEGA medical center reports that the organization does not employ any direct guidelines on the process of depression screening, which leaves nurses without appropriate guidance and support.
However, effective screening is crucial for timely interventions and patients’ health (Petrosyan et al., 2017; Taylor, 2014). The issue is aggravated by the fact that depression is a significant and rather prevalent health concern, which puts a strain on healthcare and related expenditures (Duhoux, Fournier, Gauvin, & Roberge, 2012; Petrosyan et al., 2017). It decreases the quality of life in patients and can be associated with increased mortality (Petrosyan et al., 2017). In the US, the percentage of adults older than 50 years who have been diagnosed with a major depressive episode amounted to 4.8% in 2015 (Center for Behavioral Health Statistics and Quality, 2016, p. 3055).
Given the prevalence of depression, the possibility of its ineffective screening is a significant concern. According to Petrosyan et al. (2017), an appropriate solution to this problem would be the introduction of direct evidence-based guidelines. An example of such guidelines is the APA (2016) Practice guidelines for the psychiatric evaluation of adults, and they can be employed to solve the meso-level problem of the VEGA medical center and its nurses and help them to improve the quality of depression screening in older adults.
Practice Change
The proposed practice change is aimed at the standardization of the depression screening guidelines that are used by the VEGA medical center. It will involve the introduction of the APA (2016) guidelines for the diagnosis of depression.
Population
The population in question includes the VEGA nurses of any age and gender and with any level of education and number of years of experience. The topic of nurses managing depression is not under-researched, which is why its support in recent literature should be sufficient.
Intervention
The APA (2016) screening guidelines are going to be employed as the intervention. They are evidence-based and updated; according to the AORN model for evidence rating, such guidelines can be viewed as sufficient evidence for a practice to be recommended (Spruce, Wicklin, Hicks, Conner, & Dunn, 2014, p. 253). There are not enough articles that offer research on the implementation of APA (2016) guidelines as a whole, but there is extensive evidence on various aspects of the practice being appropriate.
For example, the requirement for cultural factors and substance abuse assessment during diagnosing is well-supported by literature (Chan, Huang, Bradley, & Unützer, 2014; Dagher & Green, 2015; Evans-Lacko & Knapp, 2014; Hsieh & Bean, 2014; Illangasekare, Burke, Chander, & Gielen, 2013; Large, Mullin, Gupta, Harris, & Nielssen, 2014; Lin, Liu, & Jang, 2014; Loon, Schaik, Dekker, & Beekman, 2013; Ortíz-Gómez, López-Canul, & Arankowsky-Sandoval, 2014; Reed, Nugent, & Cooper, 2015). The intervention is not yet implemented at the VEGA medical center; as a nurse leader who is supported by the organization’s management, I can lead this intervention and ensure its introduction into practice.
Comparison
The comparison is the standard practice at the VEGA medical center, which is the absence of a standardized guideline. Duhoux et al. (2012) report that the employment of effective guidelines improves the health outcomes of patients with depression and makes illness management more cost-effective. Thus, the present practice at VEGA is a problem that should be resolved.
Outcome
The changes in the quality of depression screening are viewed as the outcome of this project; the desired outcome is its improvement. Duhoux et al. (2012) state that quality indicators for depression management are underdeveloped. Duhoux et al. (2012) and Petrosyan et al. (2017) suggest their interpretation of the criteria, basing them on quality indicators employed by an organization and expanding them with the help of literature review.
However, these quality indicators are not meant specifically for screening, which is why they may not satisfy the needs of the proposed project. As a result, the tool for outcomes measurement may need to be developed. It will follow the examples of the works by Duhoux et al. (2012) and Petrosyan et al. (2017) and use already-established, valid criteria while enhancing them with new ones. To improve the reliability (consistency of results) and validity (the ability to measure the quality of screening) of the new tools, several independent specialists will assess them (Polit & Beck, 2017).
Timing
The expected timing of the project is between eight and ten weeks, which should be enough for the introduction of the change, key measurements, and the measurement of the short-term outcomes.
Feasibility
The practice change is of interest to the stakeholders and the VEGA medical center, which is demonstrated by the letter of support. The standardization of guidelines and the use of evidence-based ones is a step towards quality improvement for VEGA. The project is also likely to be of help for the nurses and improve their confidence in their ability to work with depression. Finally, both these outcomes are expected to culminate in improved depression management, which is of importance for patients.
The timeline should be sufficient for gathering baseline data, introducing new guidelines and providing training on their use, and collecting data on the outcomes. Naturally, a more longitudinal study would produce more extended results. If the organization deems it feasible, an update may be carried out later, but it is not going to be a part of the current project.
References
APA. (2016). Practice guidelines for the psychiatric evaluation of adults.
Center for Behavioral Health Statistics and Quality. (2016). Results from the 2015 national survey on drug use and health: Detailed tables.
Chan, Y. F., Huang, H., Bradley, K., & Unützer, J. (2014). Referral for substance abuse treatment and depression improvement among patients with co-occurring disorders seeking behavioral health services in primary care. Journal of substance abuse treatment, 46(2), 106-112.
Dagher, R. K., & Green, K. M. (2015). Do depression and substance abuse co-morbidity affect socioeconomic status? Evidence from a prospective study of urban African Americans. Psychiatry research, 225(1), 115-121.
Duhoux, A., Fournier, L., Gauvin, L., & Roberge, P. (2012). Quality of care for major depression and its determinants: A multilevel analysis. BMC Psychiatry, 12(1), 1-15.
Evans-Lacko, S., & Knapp, M. (2014). Importance of social and cultural factors for attitudes, disclosure and time off work for depression: Findings from a seven country European study on depression in the workplace. Plos ONE, 9(3), e91053.
Hsieh, A., & Bean, R. (2014). Understanding familial/cultural factors in adolescent depression: A culturally-competent treatment for working with Chinese American families. The American Journal of Family Therapy, 42(5), 398-412.
Illangasekare, S., Burke, J., Chander, G., & Gielen, A. (2013). The syndemic effects of intimate partner violence, HIV/AIDS, and substance abuse on depression among low-income urban women. Journal of Urban Health, 90(5), 934-947.
Large, M., Mullin, K., Gupta, P., Harris, A., & Nielssen, O. (2014). Systematic meta-analysis of outcomes associated with psychosis and co-morbid substance use. Australian & New Zealand Journal of Psychiatry, 48(5), 418-432.
Lin, S., Liu, J., & Jang, Y. (2014). The role of psychosocial and cultural factors as correlates of depressive symptoms in Chinese-American older adults. Clinical Gerontologist, 37(2), 108-119.
Loon, A., Schaik, A., Dekker, J., & Beekman, A. (2013). Bridging the gap for ethnic minority adult outpatients with depression and anxiety disorders by culturally adapted treatments. Journal of Affective Disorders, 147(1-3), 9-16.
Ortíz-Gómez, L. D., López-Canul, B., & Arankowsky-Sandoval, G. (2014). Factors associated with depression and suicide attempts in patients undergoing rehabilitation for substance abuse. Journal of affective disorders, 169, 10-14.
Petrosyan, Y., Sahakyan, Y., Barnsley, J., Kuluski, K., Liu, B., & Wodchis, W. (2017). Quality indicators for care of depression in primary care settings: A systematic review. Systematic Reviews, 6(1), 1-14.
Polit, D.F., & Beck, C.T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Reed, K. P., Nugent, W., & Cooper, R. L. (2015). Testing a path model of relationships between gender, age, and bullying victimization and violent behavior, substance abuse, depression, suicidal ideation, and suicide attempts in adolescents. Children and youth services review, 55, 128-137.
Spruce, L., Wicklin, S. A., Hicks, R. W., Conner, R., & Dunn, D. (2014). Introducing AORN’s new model for evidence rating. AORN Journal, 99(2), 243-255. Web.
Taylor, W. (2014). Depression in the elderly. New England Journal of Medicine, 371(13), 1228-1236.