Date of Award

Spring 5-27-2023

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Dr. Rachel Gerard-Buonomo DNP, FNP-BC, AGPCNP-BC

Abstract

Introduction: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project was to emphasize the importance and address the frequency of depression screenings for patients 65 years and older who reside at a nursing home. The first goal was to conduct a retrospective chart review of 18 patients residing at an assisted living facility (ALF) to determine whether a depression screening was completed two-four weeks after admission. The second goal was to educate ALF staff on evidenced-based practice of the importance and frequency of depression screenings for the elderly. The third goal was to increase ALF staff knowledge on how to conduct a depression screening and what specific depression screenings were appropriate for their clientele.

Background: Depression in older adults often goes undiagnosed and untreated because it is often unscreened and characterized as a normal part of aging. Depression affects more than 6.5 million Americans aged 65 and older. Geriatric patients who reside at nursing homes (NH) are at high-risk to develop depression. The American Geriatric Society recommends depression screening two to four weeks after admission to a nursing home and then repeated screening at least every six months after admission. Determining the presence of depression in NHs is difficult due to other concurrent neurological diagnoses, but it is important to differentiate depression symptoms and begin appropriate treatment to support improved patient outcomes.

Methods: The IOWA model was used to guide implementation of this pilot project. A questionnaire composed of five multiple choice questions was provided before and after a fifteen-minute educational in-service to determine whether staff understood how to administer the specified depression screening tool and appropriately decide what tool was appropriate for each patient.

Results: After chart review, there were zero charts that showed any depression screenings from time of admission. However, after the educational in-service, there was a significant increase in depression screening knowledge. The average pre-test score was 28% and the post-test average was 92%, reflecting an overall 228.57% increase in depression screening understanding. After said education, the staff was asked if they were willing to commit to incorporate appropriate screening tools in their practice moving forward and a resounding 100% were affirmative.

Evaluation: In keeping with the recommendations of the USPSTF, screening is of clear benefit only in settings that have the means to offer accurate diagnosis, effective treatment, and monitoring over time. Healthcare staff working in primary care should have access and knowledge in appropriate screening tools. Additional research is needed to expand awareness of depression screening frequency within nursing homes utilizing tools over an appropriate span of time.

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