Nursing Commons^™

Quality Improvement Project: Advancing Personalized Depression Care In Outpatient Psychiatry, Jillian K. Benoit

Doctor of Nursing Practice Projects

Depression is a leading cause of disability worldwide, yet inconsistent use of evidence-based assessment and treatment strategies contributes to gaps in the quality of psychiatric care. A needs assessment at a community outpatient psychiatric clinic identified inconsistent documentation of measurement-based care (MBC), shared decision-making (SDM), and patient education during depression treatment. The purpose of this quality improvement project was to evaluate whether implementation of MBC and SDM improved depression treatment documentation among psychiatric providers over a 4-week period. Guided by Lewin’s Change Theory and implemented using the Iowa Model of Evidence-Based Practice as the implementation framework, this quantitative one-group pretest-posttest …

Implementation Of Phq-9 To Improve Depression Identification In Icu, Jenny C. Manoly Bsn, Rn

Doctor of Nursing Practice Final Project Abstract

PURPOSE This quality improvement project aimed to improve depression identification by screening 80% of eligible adults admitted to two heart failure intensive care units (ICU) using the Patient Health Questionnaire-9 (PHQ-9).

RESULTS Screening compliance increased from 42.1% to 85% by Week 13, exceeding the project goal. Of 101 patients screened, 16.8% screened positive for depression. Workflow changes, leadership support, and peer engagement improved compliance, though psychiatric referrals remained inconsistent.

BACKGROUND Depression is common among critically ill patients but is frequently underrecognized because ICU care primarily focuses on physiologic stabilization. Existing admission screening was limited to suicide risk assessment, delaying identification …

Mindfulness To Reduce Psychotropic Prescriptions In Home-Based Elderly Patients, Mojisola Akinola Olusegun

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Home-based adults aged 65 years and older receiving care at a community behavioral health center exhibited high psychotropic polypharmacy, with over 80% prescribed two or more psychotropic medications, exceeding The Center for Medicare and Medicaid services (CMS) guidance for safe use. This pattern heightened risks for adverse drug events, functional decline, and avoidable healthcare utilization, while exposing a practice gap characterized by underuse of non-pharmacologic interventions.

Aim of the Project: The Doctor of Nursing Practice (DNP) project aimed to determine whether integrating a structured Mindful Breathing and Meditation (MBM) program into routine services could reduce psychotropic medication burden …

The Impact Of Translated Phq-9 And Gad-7 Scales On Treatment Recommendations In An Adult Vietnamese Population: A 3-Month Primary Care Evaluation, Vivienne Bui

Doctor of Nursing Practice Final Manuscripts

Depression and anxiety are prevalent yet underdiagnosed in limited-English-proficient (LEP) populations due to language barriers, cultural stigma, and provider bias. Vietnamese-speaking patients are particularly vulnerable to under-recognition in primary care. This quality improvement project evaluated whether implementing Vietnamese-translated Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) tools would improve mental health diagnosis and referral rates. Guided by the Johns Hopkins Evidence-Based Practice Model, a pre–post design was conducted at a San Diego clinic from March 26 to June 26, 2025. Vietnamese-speaking adults (≥18 years) completed translated PHQ-9 and GAD-7 forms during intake. Providers used scores in conjunction with clinical …

Medication-Assisted Treatment For Patients With Substance Use Disorder And Depression: A Scoping Review, Josiane Deguenon Bsn-Rn, Elisabeth Fritz Bsn-Rn, Jesse Jean Bsn-Rn, Tucker Mckinney Bsn-Rn, Laura Reed Dnp, Aprn, Fnp-Bc, Cne, Fnap

Doctor of Nursing Practice Projects

Purpose/Background

Substance use disorder (SUD) frequently co-occurs with depression and increases relapse risk and healthcare utilization. Although medication-assisted treatment (MAT) is an evidence-based intervention for SUD, outcomes for adults with co-occurring depression remain inconsistently reported due to variation in study designs, treatment settings, and measures. This scoping review examines evidence on MAT use among adults with co-occurring depression and SUD and summarized reported clinical and healthcare utilization outcomes.

Methods

From August 2023 to November 2025, a scoping literature review was conducted on PubMed/MEDLINE, CINAHL, and the Cochrane Library, using MeSH search terms and Boolean operators to link the concepts defined …

A Retrospective Chart Review: Screening Patients With Type 2 Diabetes For Depression, Jennifer Sheldon, Glynnis Haley, Monica Ketchie

The Corinthian

Type 2 Diabetes Mellitus is defined as an impaired production of insulin resulting in elevated blood glucose levels (Brutsaert E., 2020). Globally, approximately 8% to 9% of adults have diabetes mellitus, the majority of which (95%) have Type 2 Diabetes Mellitus, equating to between 624 million to 702 million people (WHO, 2020). Type 2 Diabetes Mellitus represents the seventh leading cause of death, with approximately 1.5 million new cases diagnosed annually in the United States (CDC, 2020).

Depression is clinically defined as a mental health disorder that presents with a continually depressed mood or a loss of interest in daily …

Treating Depression With L-Methylfolate: A Review Of Evidence, Marianna G. Pettit

Epsilon Sigma at-Large Research Conference

Abstract

Introduction & Background: Depressive disorders have many different causes. Folate deficiency can sometimes be behind these disorders, due to this vitamin’s role in neurotransmitter synthesis. Some research suggests that supplementing with an active form of folate improves depressive symptoms with and without antidepressant use. Purpose Statement Question: For individuals with depressive disorders, does supplementation with L-methylfolate (LMF) reduce symptoms of depressive disorders with or without use of an antidepressant? Literature Review: A manual literature search for sources published within the past 7 years revealed 557 documents from four different databases. Key search words included, “depression,” “treatment,” …

Does Mandated Paid Maternity Leave Affect Postpartum Depression?, Amaya S. Hall, Shay Y. Bullwinkel, Loran M. Hurley, Sara Cook

Epsilon Sigma at-Large Research Conference

This project analyzes the effects that paid maternity leave has on postpartum depression. Upon reviewing multiple studies, it has been demonstrated that unpaid maternity leave is associated with postpartum depression. Throughout researching postpartum depression rates, it has been proven to be much higher in unpaid leave compared to paid maternity leave. Mothers that have the burden of staying home with their infants and having to juggle time off work, without being compensated, are at an increased risk of experiencing postpartum depression. It has been shown that when a mother is able to focus on her child and her healing after …

Building Adult-Gerontology Acute Care Nurse Practitioner Student Competencies For Telemental Health Treatment Through Simulation, Amy Dievendorf Dnp, Aprn, Fnp-Bc, Agacnp-Bc, Phyllis Raynor Phd, Aprn, Pmhnp-Bc, Beverly Baliko Phd, Rn, Pmhnp-Bc, Abbas Tavakoli Drph, Mph, Me

Publications

Depressive disorders are common mental health conditions that are often undiagnosed or undertreated. Adult-Gerontology Acute Care Nurse Practitioners (AGACNPs) are educated in the management of acute and critically ill patients but are often uncomfortable identifying and treating mental health conditions. Telehealth instruction is useful in mental healthcare and is required as part of the AGACNP’s efficient patient care competencies. This article reports findings from a mental health-focused telehealth instructional activity integrated into an existing AGACNP curriculum. This instructional activity was designed to introduce students to telehealth delivery and build AGACNP competencies using telehealth technology to assess patients with depressive mood …

Quality Improvement Project: The Impact Of Staff Education On Utilization Of The Phq-9 Tool And Follow-Up Management Protocol, Shuntak Jerideau

Doctor of Nursing Practice Projects

Depression is a prevalent mental health disorder that affects daily functioning. Timely screening enables the identification of symptoms, monitoring treatment efficacy, and informs additional treatment such as referrals. The practice site reported low screening rates of patient’s post-psychiatric hospitalization, which was attributed to inadequate knowledge of the PHQ-9 tool. The purpose of this quality improvement project was to evaluate the impact of staff education on the utilization of the PHQ-9 tool and follow-up management protocol in a mental health clinic. A quasi-experimental design method was used in an outpatient mental health clinic. Pretest knowledge of the PHQ-9 was obtained from …

Impact And Effectiveness Of Phq-9 Training For School Counselors On Mental Health Referrals For High School Students, Sherikee Dorice Grim Bsn, Rn, Ja’Quay Brister Dnp, Pmhnp-Bc, Margaret Harvey Phd, Aprn, Acnp, Chfn, Fhrs

Doctor of Nursing Practice Projects

Purpose/Background

Adolescents' mental health has worsened and become a public health issue, with depression being a primary concern. There is an urgent need for early screening, school-based referral pathways, and interventions to address common problems in high schools. Patient Health Questionnaire-9 (PHQ-9) is a validated, evidence-based tool for detecting depression; however, its systematic use in school-based counseling settings through organized training has not been studied for implementation in high schools. This review assesses the current literature on the impact and effectiveness of PHQ-9 training for school counselors on mental health referrals among high school students, with a focus on early …

Program Evaluation Of Tms Treatment For Patients With Comorbid Major Depressive Disorder And Ptsd, Alec Wilson

Doctor of Nursing Practice

Nearly six million in the U.S. experience symptoms associated with the diagnoses of comorbid Major Depressive Disorder (MDD) and Post Traumatic Stress Disorder (PTSD). Many with these diagnoses fail to respond to first line treatments that include medication and psychotherapy. Transcranial magnetic stimulation (TMS) therapy is a non-invasive treatment option for individuals who fail to respond to first line treatments.

Methods: This program evaluation completed a retrospective chart review of adult patients with comorbid MDD and PTSD, who received TMS treatments at a private practice clinic between the time frame of September 2024 and October of 2025.

Results: All …

Implementing A Standardized Ssri Tapering Protocol In The Outpatient Setting, Chelsea Sopo-Ngwa

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Selective serotonin reuptake inhibitors (SSRIs) are one of the most prescribed antidepressant medications in the outpatient psychiatric setting. Abrupt discontinuation or improper tapering of these medications may result in SSRI withdrawal symptoms. Adverse effects may lead to poor patient outcomes and increase healthcare utilization. A baseline chart review and provider readiness survey within the outpatient psychiatric practice revealed inconsistency in provider documentation related to SSRI tapering plans, patient education, and follow-up planning. The gap in practice highlighted the lack of a standardized SSRI tapering protocol to guide evidence-based medication tapering practices and promote patient safety.

Aim: The …

Skin-To-Skin Contact At Birth For Very Preterm Infants And Symptoms Of Depression And Anxiety In Parents During The First Year – A Secondary Outcome Of A Randomized Clinical Trial, Siri Lilliesköld, Karoline Lode-Kolz, Björn Westrup, Nils Bergman, Kimmo Sorjonen, Ulrika Ådén, Evalotte Mörelius, Siren Rettedal, Wibke Jonas

Research outputs 2022 to 2026

Background: Mental health issues are common in parents to preterm infants. In the neonatal intensive care unit (NICU), skin-to-skin contact (SSC) as an avenue for parent-infant closeness may improve parental mental health. Few studies exist regarding its benefits when initiated immediately postbirth. The aim was to determine the effect of SSC for very preterm infants at birth on parents' mental health, by assessing symptoms of depression and anxiety within the first year. Methods: The Immediate Parent-Infant Skin-to-Skin Study was a randomized clinical trial conducted 2018–2021 at three NICUs in Sweden and Norway. Very preterm infants (28–33 weeks of gestation) were …

Quality Improvement Project Integrating Clinical Decision-Making Tools Within An Ehr System For Provider-Enhanced Diagnosis And Treatment Of Depression In Primary Care, Theresa Ojoye

Doctor of Nursing Practice Projects

The inconsistent management of depression in primary care settings persists despite numerous available treatments, which current behavioral health literature frequently addresses.  A review of the project site highlighted the inconsistency in diagnosing and managing depression due to varying levels of provider familiarity with current guidelines and a lack of integrated decision-support tools within the Electronic Health Record (EHR) system. This project aims to evaluate the impact of integrating a clinical decision-making tool and patient outcomes in managing depression. This Quality Improvement (QI) project implemented UpToDate as an evidence-based clinical resource within the EHR system to address inconsistent application of evidence-based …

Improving The Screening And Management Process For Mental Health Disorders And Health Risk Behaviors In College-Age Students: A Quality Improvement Project, Brooke L. Styslinger

Doctor of Nursing Practice (DNP) Manuscripts

Establishing a standardized electronic screening process for mental health disorders and health risk behaviors is crucial for early identification and intervention before poor outcomes occur. This quality improvement project addresses a gap in care relating to screening practices in a college health services office which primarily relied on a provider-based interview screening processes in students reporting for care. Pre-implementation data showed providers most often screened for Major Depressive Disorder (MDD), alcohol use, and drug use, with inconsistent screening for Generalized Anxiety Disorder (GAD) or tobacco/vaping use. Follow-up screening form administration was also inconsistent, only given 3.3% of the time for …

Correlation Between Family Support And Depression Among Pre-Elderly Individuals With Hiv In Jakarta, Gracella Tanjaya, Surilena Surilena, Nicholas Hardi, Eva Suryani

Jurnal Keperawatan Indonesia

Depression among pre-elderly with human immunodeficiency virus (HIV) can significantly impact their quality of life. Family is often the primary source of support for this demographic and is recognized as a protective factor against depression. Therefore, identifying protective factors against depression is essential for promoting healthy aging among pre-elderly with HIV. This study aimed to determine the correlation between family support and depression among pre- elderly with HIV in Jakarta. A total of 120 pre-elderly with HIV from the Indonesia AIDS Coalition who were receiving HIV care at health centers across Jakarta participated in this cross-sectional study. The participants were …

Implementation Of Mindfulness-Based Interventions And Weekly Visits To Reduce Loneliness In Older Adults, Victoria E. Cobb

Dissertations

Implementation of Mindfulness-Based Interventions and Weekly Visits to Reduce Loneliness in Older Adults

Abstract:

Problem: Social isolation and loneliness have emerged as a significant public health issue for the older adult population. Loneliness has been linked to both physical and mental health effects. According to current literature, there is no standard intervention to treat loneliness in the older adult population.

Methods: This quality improvement (QI) project utilized a descriptive cohort design and the Visit-A-Bit screening assessment instrument. Undergraduate nursing students implemented mindfulness interventions during weekly visits over an eight-week period at an independent living facility located in the Midwest. Descriptive …

The Psychological Impact Of Parenting Child Victims Of Trauma, Stephanie Faulkingham

Dissertations

Abstract

Research indicates that non-offending caregivers of traumatized children (NOC) is a population with an elevated risk for increased levels of depression and anxiety and are an underserved population for mental health services. The purpose of this quality improvement project was to determine if screening caregivers of traumatized children using the Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder (GAD-7) improves identification of depression and anxiety. Participants of this investigation were individuals enrolled in the Children’s Advocacy Services of Greater St. Louis’ 12-week parenting group, TASK (Trauma, Assessment, Skills, and Knowledge). Each participant was asked to complete the PHQ-8 and …

Depression Screening In The Adult Inpatient Oncology Population, Erica Bizub

Dissertations

Routinely screening oncology patients for depression is recommended due to the higher rates of depression in this population as well as the negative impact of untreated depression. The goal of this QI project is to implement a standard depression screening protocol for patients admitted to this hospital, where there is currently no standard screening protocol. There were 110 patients included in this study, and 67 (60.91%) of patients received a PHQ-9 screening. Of the patients who completed the PHQ-9, 21 (19.09%) had a positive screening, which was a score of seven or higher. While there were high rates of provider …

Predictors Of Nursing Students' Stress, Anxiety, And Depression During The Covid-19 Pandemic In A Hispanic-Serving University In South Texas: A Cross-Sectional Study, Maria I. Diaz, Eleftherios Gkioulekas, Nancy Nadeau

School of Mathematical & Statistical Sciences Faculty Publications

Background: In nursing education, there have been several studies on the impact of the COVID-19 pandemic on the ability of nursing students to cope while in nursing school.

Purpose statement: The goal of this study is to assess undergraduate nursing students' support mechanisms as predictors of stress, anxiety, and depression during the COVID-19 pandemic within a Hispanic-serving institution in South Texas.

Methods: Across-sectional design was used in this study. An online survey using self-reported questionnaires was used to gather data from an undergraduate nursing student cohort during the Fall 2021 semester. Linear regression was used to identify the predictors of …

Staff Education On Physical Activity As A Therapeutic Option For Anxiety And Depression, Suja Paul

Walden Dissertations and Doctoral Studies

This project’s aim was to educate staff on physical activity (PA) as a therapeutic option for anxiety and depression to relieve psychotic symptoms, enhancing patients’ quality of life. PA enhances cognitive functioning, reduces anxiety and depression, and decreases the risk of cardiovascular conditions and early death. Patients with severe mental illnesses face barriers to PA and exercise, so providers and policymakers must create an environment that encourages participation. A knowledge gap for staff exists in promoting PA in mental health patients. Healthcare professionals should recommend the right amount of PA for each patient. This initiative aims to increase staff confidence …

Increasing Depression Risk Screening In Hospice And Palliative Care Patients, Elizabeth Kanini Michaels

Walden Dissertations and Doctoral Studies

This doctoral project was conducted as a staff education project. The practice problem involved inconsistent depression risk screening in hospice and palliative care patients. It was crucial to address this, as depression can be pervasive in this population. The practice-focused question was, For registered nurses who work in a palliative or hospice care unit, does education on depression risk screening increase depression screening rates as compared 12 weeks before to 12 after the education? The project aimed to improve depression risk screening rates through staff education. The Johns Hopkins nursing evidence-based practice model was used to assess 13 supporting articles …

Staff Education To Enhance Nurse Knowledge Of Depression And Screening Tool Using Patient Health Questionnaire-9, Oluwakemi Omotayo Aregbesola

Walden Dissertations and Doctoral Studies

Summary This staff education program focused on addressing a practice deficit regarding nonstandard depression assessment and substandard nurse knowledge of evidence-based screening tools, mainly the Patient Health Questionnaire-9 (PHQ-9), a nine-item, self-reporting test used to screen for depression and assess severity of the condition based on the Diagnostic and Statistical Manual of Mental Illnesses, 5th Edition. Depression exists as a familiar yet unidentified disorder among psychiatric inpatients, resulting in delayed treatment inferior outcomes. The staff education project targeted the nurses’ knowledge of depression identification while also teaching them to administer the PHQ-9 for prompt screening and intervention. I used an …

Maternal Depression And Covid-19: A Secondary Analysis Comparing Postnatal Depression Rates During And Before The Covid-19 Pandemic, Amanda A. Berney

2025 Spring Honors Capstone Projects - Archive

The COVID-19 pandemic created increased psychological vulnerability across the globe through isolation, fear of infection, and misinformation from various sources, including social media. Women giving birth during the pandemic, therefore, may be extremely vulnerable psychologically. Per the World Health Organization, the years 2020 to mid 2021were designated as an intense time during the COVID-19 pandemic. Thus, the objective of this secondary analysis was to compare depression scores among women giving birth during these intense years and women giving birth before 2020. However, due to a small window of time and sample size, statistical analysis failed to find a correlation between …

Polypharmacy And Pharmacogenomics In High-Acuity Behavioral Health Care For Autism Spectrum Disorder: A Retrospective Study, Sheldon R. Garrison, Sophie A. Schweinert, Matthew W. Boyer, Maharaj Singh, Sreya Vadapalli, Jeffery M. Engelmann, Rachel A. Schwartz, Madeline M. Hartig

College of Nursing Faculty Research and Publications

Background

This study evaluated pharmacogenomic (PGx) testing in children and adolescents with autism spectrum disorder (ASD). ASD frequently presents with co-occurring depression and anxiety. This complex phenotype often results in psychotropic medication polypharmacy. Incorporating PGx testing into the medical work-up may reduce polypharmacy and improve quality of life with symptom reduction.

Methods

A retrospective electronic health record (EHR) review between January 2017 and May 2023. Individuals either received PGx testing or treatment as usual (TAU). The co-primary outcomes were instance of polypharmacy and the Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q). Secondary outcomes included length of stay, average …

To Heal A Mind: A Comparison Of Functional And Conventional Treatments In Major Depressive Disorder, Gillian Chambers

Senior Honors Theses

Incidence of major depressive disorder is increasing year over year, with little able to be done to halt the spread of the condition. However, there are many treatment possibilities considered unconventional by the healthcare system. This thesis examines the respective benefits and risks, in comparison to one another, between conventional pharmacological treatment and functional, holistic treatment of depression. This was done via integrative review of available clinical literature, synthesizing evidence on both conventional and functional treatments for depression, as dictated by Whittemore and Knafl (2005). Exploratory search methods revealed 758 records fulfilling inclusion criteria, which were screened and narrowed down …

Enhancing Provider Knowledge With Phq-9 Education, Laurette Abunaw

Walden Dissertations and Doctoral Studies

Depression represents a significant public health concern that often remains undiagnosed or untreated, primarily due to insufficient systematic screening in primary care settings. The lack of standardized screening tools such as the Patient Health Questionnaire-9 (PHQ-9) elevates patient risks, increasing symptom severity, increasing suicide rates, and delaying interventions. Research studies show that a significant number of individuals with depression go untreated for long durations, with primary care settings recognizing only a small percentage of cases. The PHQ-9 is an effective tool for assessing and monitoring depression in a primary care setting, leading to early detection of symptom severity. Clinical practice …

Pharmacogenomics-Guided Treatment Of Depression Evidence-Based Practice Scholarly Project, Richard A. Sonnier

Doctoral Dissertations and Projects

Pharmacogenomics is a popular topic in psychiatry today that is poised to replace the outdated trial-and-error paradigm of prescribing psychotropic medications. For patients suffering from a myriad of psychiatric disorders, it has been a frustrating period for those who have struggled with multiple failed trials of medications before finding relief from debilitating depression, anxiety, and many other mood-dysregulating disorders. Often, patients are forced to endure several weeks or months of trying psychotropic agents with poor responses and intolerable side effects before finally finding a medication that yields a desired outcome. In some cases, no therapeutic response is ever achieved. With …

Exploring Maternal-Infant Attachment And Its Relationships With Perinatal Depression And Anxiety Symptoms And Breastfeeding Self-Efficacy Among Predominantly Hispanic, Latina, And African American/Black Marginalized Populations, Leslie B. Lantz, Amy Salisbury, Sara Moyer, Sally Russell, Leroy Thacker, Candice Gault, Josselyn Valenzuela, Merilyn Arikkat, Maria Mooney, S Bodnar-Deren, Patricia Kinser

School of Nursing Publications

The purpose of this study is to explore maternal-infant attachment at 26 weeks PP as it relates to concurrent postpartum depression and anxiety symptoms and breastfeeding self-efficacy in ethnically diverse postpartum mothers (from a larger RCT [“Mindful Moms Study”]).