Date of Award

Spring 5-27-2023

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Pedro Colio, PhD, DNP, FNP-C, ENP-C


Background: 11.7% of adults aged 18 and over have regular feelings of worry, nervousness, or anxiety. Anxiety can often present with somatic symptoms. The rates of misdiagnoses are high with symptoms often attributed to physical etiologies. Early recognition and treatment of anxiety can improve quality of life, prevent complications and reduce health care costs.

Purpose of Project: Implementation of the Generalized Anxiety Disorder 2-item (GAD-2) screening tool in a fast-paced underserved outpatient cardiology clinic for adult patients presenting with chest pain and/or palpitations without documented history of anxiety. The purpose of this project is to improve the utilization of the GAD-2 survey when clinically appropriate. Positive GAD-2 scores will prompt cardiology providers to refer patients for further evaluation of GAD regardless of the evaluation of cardiovascular disorders.

Evidence-Based Intervention: The Iowa Model of Research guided this practice change. The literature supports the utilization of the GAD-2 survey to screen patients for GAD. Cardiology providers will receive one-on-one training on the use of the GAD-2 survey as part of the history and physical for adult patients presenting with chest pain and palpitations.

Results: Preintervention, retrospective, baseline data was collected for a period of three months in order to obtain a good sample (n = 30) for comparison. Three months post intervention data was collected and assessed for adherence to the practice guideline (n = 23). The findings demonstrated 100% improvement in screening and referral when appropriate.

Implications for Clinical Practice: Appropriate use of the GAD-2 screening tool improved early identification and referral of individuals at risk of GAD presenting with cardiac symptoms. Early intervention of GAD improves quality of life and reduces healthcare related costs.