Running head: PEDIATRIC DEPRESSION SCREENING
EFFECTIVE STAFF TRAINING IN ADMINISTERING PEDIATRIC DEPRESSION
SCREENINGS
Nakeshia Lynn Mouzon
Capstone Paper submitted in partial fulfillment of the
requirements for the degree of
Doctor of Nursing Practice
Chatham University
07 April 2019
Signature Faculty Reader
Date
Signature Program Director
Date
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PEDIATRIC DEPRESSION SCREENING
Acknowledgments
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PEDIATRIC DEPRESSION SCREENING
Abstract
Start typing here….
Key words:
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PEDIATRIC DEPRESSION SCREENING
Table of Contents
Acknowledgments..................................................................................................................2
Dedication ..............................................................................................................................X
Abstract .................................................................................................................................. 3
Chapter One: Overview of the Problem of Interest ..............................................................8
Background Information ............................................................................................9
Significance of the Problem .......................................................................................12
Question Guiding Inquiry (PICO) .............................................................................14
Variables of the PICO question .....................................................................15
Summary ....................................................................................................................16
Chapter Two: Review of the Literature/Evidence ................................................................18
Methodology ..............................................................................................................18
Sampling strategies ........................................................................................19
Inclusion/Exclusion criteria ...........................................................................19
Literature Review Findings........................................................................................20
Discussion ..................................................................................................................27
Limitation of literature review. ......................................................................28
Conclusions of findings .................................................................................28
Potential practice change ...............................................................................29
Summary ....................................................................................................................29
Chapter Three: Theory and Model for Evidence-based Practice ..........................................32
Theory ........................................................................................................................32
Application to practice change.......................................................................36
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Model for Evidence-Based Practice ..........................................................................39
Application to practice change.......................................................................42
Summary ....................................................................................................................45
Chapter Four: Pre-implementation Plan ...............................................................................X
Project Purpose ..........................................................................................................X
Project Management ..................................................................................................X
Organizational readiness for change ..............................................................X
Inter-professional collaboration .....................................................................X
Risk management assessment ........................................................................X
Organizational approval process ....................................................................X
Use of information technology ......................................................................X
Materials Needed for Project .....................................................................................X
Plans for Institutional Review Board Approval .........................................................X
Plan for Project Evaluation ........................................................................................X
Plan for demographic data collection ............................................................X
Plan for outcome data collection and measurement ......................................X
Plan for evaluation tool ........................................................................X
Plan for data analysis ...........................................................................X
Plan for data management ..............................................................................X
Summary ....................................................................................................................X
Chapter Five: Implementation Process .................................................................................X
Setting ........................................................................................................................X
Participants .................................................................................................................X
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Recruitment ................................................................................................................X
Implementation Process .............................................................................................X
Plan Variation ............................................................................................................X
Summary ....................................................................................................................X
Chapter Six: Evaluation and Outcomes of the Practice Change ...........................................X
Participant Demographics ..........................................................................................X
Table or Figure X ...........................................................................................X
Table or Figure X ...........................................................................................X
Outcome Findings ......................................................................................................X
Outcome One .................................................................................................X
Table or Figure X ...........................................................................................X
Table or Figure X ...........................................................................................X
Summary ....................................................................................................................X
Chapter Seven: Discussion ...................................................................................................X
Recommendations for Site to Sustain Change .........................................................X
Plans for Dissemination of Project ..........................................................................X
Project Links to Health Promotion/Population Health ............................................X
Role of DNP-Prepared Nurse Leader in EBP ..........................................................X
Future Projects Related to Problem .........................................................................X
Implications for Policy and Advocacy at All Levels ...............................................X
Summary ..................................................................................................................X
Chapter Eight: Final Conclusion ...........................................................................................X
Clinical Problem ........................................................................................................X
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Evidence Base ............................................................................................................X
Theory and Model for Evidence-based Practice ........................................................X
Project Management ..................................................................................................X
Project Implementation ..............................................................................................X
Outcome Findings ......................................................................................................X
Discussion Summary .................................................................................................X
Final Conclusions...................................................................................................................X
References ..............................................................................................................................X
Appendix A: XXXXXX .......................................................................................................X
Appendix B: XXXXXX ........................................................................................................X
Appendix C: XXXXXX........................................................................................................X
Appendix D: XXXXXX .......................................................................................................X
Appendix E: XXXXXX ........................................................................................................X
Appendix F: XXXXXX ........................................................................................................X
Appendix G: XXXXXX .......................................................................................................X
Running head: PEDIATRIC DEPRESSION SCREENING
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Chapter One: Overview of the Problem of Interest
Depression in Children
Depression has become an issue of concern due to its impact on the adult population.
However, depression in children has been largely ignored, and it is only in the past few decades
that it has been taken seriously. It is more challenging to diagnose depression in children as it is
difficult to tell whether a child is undergoing a temporary phase, or if the symptoms indicate a
larger problem. Depression is an issue of global concern, as it is the leading cause of disability
for both males and females (Pennant et al., 2015). The purpose of the paper is to highlight the
impact of depression in children, and how pediatric screening can improve detection.
Background
Depression is a mental disorder characterized by depressed moods, loss of interest in
activities, lack of sleep and appetite, poor concentration, feelings of guilt, and decreased energy.
Depression may also be simply defined as having an irritable mood for at least two weeks. There
are different categories of depression involving mild, moderate, and severe. Depression may also
be categorized into major depressive disorder, mood disorders such as bipolar disorder, and
medical conditions involving hypothyroidism (Bitsko et al., 2018). Generally, depression is
noticeable due to the individual’s withdrawal from social activities.
Depression affects the individual’s ability to take care of everyday responsibilities.
Depression is linked to suicide, as up to 3,000 people under the age of 18 are said to die by
suicide each year (Bardach et al., 2014). The high suicide rates in the society are attributed to the
prevalence of depression within the population. Suicide is the leading cause of death for young
people between 10 and 24 years. Sheftall et al. (2016) estimates that for every person who
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commits suicide, there are 20 people who may think about or attempt to commit suicide.
Therefore, addressing depression may lower the prevailing suicide rates.
In children, depression is common in every age, and it affects 16% of the children in the
United States at some time in their lives. Depression is an imminent problem affecting young
people, as up to 11% of the youth in the United States are diagnosed with depression by the age
of 18 (Avenevoli et al., 2013). The high prevalence rate is an issue of concern as it demonstrates
that depression is a major issue facing young people.
Consequences of Depression in Children
Depression has negative consequences on children’s health and wellbeing. The
consequences of depression include poor performance in school due to truancy, dropping out of
school, and lack of concentration (Wolk et al., 2016). If the depression is left unchecked, it
compromises the child’s future due to poor academic performance. Children may also drop out
of school due to lack of interest in their studies. Depression is linked to increased drug and
alcohol abuse cases. When children are depressed their cognitive functioning is affected, which
makes them prone to risky behaviors. Children may also engage in unsafe sexual practices as
they may not care about their health and wellbeing. Depression results in strained relationships
with peers and family due to the children’s anti-social tendencies. Depressed children may prefer
spending time by themselves as opposed to socializing with other people. Last and most
importantly, depression is linked to suicidal behavior (Patterson, DeBaryshe, & Ramsey, 2017).
Depressed children are more likely to have suicidal thoughts
Risk Factors of Depression in Children
Depression in children is caused by psychological, biological, and environmental factors.
Children may become depressed due to psychological factors such as feeling worthless and
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inadequate. For instance, a child’s poor performance in school may result in depression if there
are negative consequences associated with poor performance. If the child is pressurized to attain
high grades by parents, sponsors, or the school, the child may become depressed over time due to
the constant worrying over their grades. Depression may occur as a result of biological
determinants involving neurotransmitters, neuroendocrine, and neurotropic factors. The
biological factors make some individuals more prone to depression than others. Environmental
factors affecting depression involve socioeconomic statuses, family setting, and race and
ethnicity (Heslin et al., 2016). Studies indicate that children from low-income and minority
communities have a higher likelihood of being depressed than their White counterparts from
high-income earning families (Kids Data, 2018). Therefore, depression does not only involve the
psychological factors, as it is also impacted by biological and environmental factors.
Depression has been linked to race and ethnicity factors. A study conducted by Kids Data
(2018) for years 2013 to 2015 indicated that children from different ethnicities have varying rates
of depression. In Los Angeles, children from various ethnic and racial communities reported
having depression-related feelings. Native Hawaiians had the highest prevalence rates at 32.5%,
followed closely by Latinos, who had a prevalence rate of 32%. The data is worrying as it
indicates that approximately 1 out of 3 children from Hispanic or Native Hawaiian ethnicities
could be having depression. The ethnic community with the lowest depression prevalence rate is
African Americans, and even so, 24.5%, or a quarter of children from the ethnic community
report having depressive thoughts. The statistics are alarming as they indicate that depression
among children is prevalent in the society across all races and ethnicities. This data from the
research article are not all inclusive, as often many children suffering from depression are
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unreported for fear or humility this may cause. This is also a cultural bias and many minority
communities deny these emotions. The data is provided below.
Table 1
Depression Prevalence among children for Different Ethnic Communities in Los
Angeles County
Barriers to Addressing Depression in Children
Unfortunately, the majority of children undergoing depression do not receive treatment
for the mental condition, and they end up having more serious mental health issues later in
adulthood. Lack of treatment is likely due to misdiagnosis. Parents and caregivers may be
unaware that their children are undergoing depression. Even when children are identified as
having depression, their conditions are often not be taken with enough seriousness to warrant
medical treatment. Diagnosing depression in children is difficult as there are no specific tests that
can diagnose the condition. Mental health experts determine if a child has depression by
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conducting interviews and screening tests with the child, peers, teachers, and family members.
The data collected from the interviews is then evaluated for signs of depression. However, the
unavailability of support systems makes the condition difficult to diagnose (Bitsko et al., 2018).
For instance, if the child’s teachers and peers are unavailable to provide information, it would be
challenging for mental health experts to diagnose the child with depression.
Significance
Depression among children needs to be addressed as it affects their mental development.
Positive mental health is critical to a healthy development, as emotional health is integral to the
overall health of a child. A study conducted by Bardach et al., (2017) indicate that up to 44% of
all pediatric mental health conditions in 2015 can be traced back to depression. Therefore,
depression is a significant mental health condition that influences the mental development of a
child. Depression inhibits the physical development of a child as it causes changes in an
individual’s self-perception and perception of others. Boyd, Bee, and Johnson (2015) indicate
that mental health contributes to the physical development of an individual as it affects
functioning in school, at home, and in other social settings.
Depression affects children’s physical development. For young children who are
depressed, they may avoid taking food or they could engage in overeating, which potentially
compromises their physical development. Boyd, Bee, and Johnson (2015) indicate that children
with existing medical conditions may find that their symptoms get worse after undergoing
depression. Depression presents itself through physical signs involving headaches, diarrhea,
constipation, insomnia, nausea, and inflammation. Children with depression also incur changes
in appetite, which consequently cause unintended weight loss or gain. Health practitioners link
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drastic change in weight to conditions such as diabetes and heart disease. Therefore, depression
in children exposes them to increased risks of chronic illnesses that affect them for the rest of
their lives.
Depression has serious cost consequences for the individual, family, and the country. In
terms of the individual, depression causes strains to parents, especially when it affects children
from low and middle income earning families. The parents may incur increased health costs
needed to cater for psychotherapy and counseling treatment. Due to the increased costs in
managing depression, the household’s finances are strained, which may affect the parents’
abilities to provide food, educational materials, and other household needs. Depression is also an
issue of great concern to the country. Mangione-Smith (2014) states that pediatric mental health
costs in 2015 increase to over, $1.33 billion, an amount that consequently increased the overall
costs of healthcare. Since more than 40% of all mental health cases are depression-related, the
country spent up to $0.53 billion in the management of depression.
Depression is related to one of the leading causes of death for children. Data provided by
Kids Data (2018) indicates that the top five causes of death for children and the youth in Los
Angeles County include suicide, cancer, homicide, heart disease, and congenital anomalies. The
data is provided below.
Table 2
Relationship between Depression and Mortality Rates in Children in Los Angeles
County
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Suicide is the top three cause of death among children in Los Angeles County. As
displayed by the table, suicide is ranked third in the cause of death among children aged between
15 to 19 years, and it is ranked third in the cause of death of individuals aged between 20 to 24
years. Studies show a high correlation between depression and suicide (Sheftall et al., 2016).
Assuming that all suicide cases are linked to depression, the mental health disorder is linked to
the deaths of 104 people in Los Angeles County between 2013 and 2015. The high suicide rates
in the county could be an indication of high depression prevalence in the area.
Addressing the issue of depression may have positive impacts on the health outcomes of
depression. Depression affects the psychological, physical and mental wellbeing of a child.
Therefore, addressing depression improves the overall health of the child (Boyd, Bee, &
Johnson, 2015). For instance, when children receive treatment for depression, they incur lower
risks for getting diabetes and heart diseases later in life. As a result, the children do not only
benefit from improved quality of life; but they also become healthier. When many children
receive treatment for depression, households will be less strained financially, while the country
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will incur reduced healthcare costs. As a result, addressing the issue of depression has positive
implications on the wellbeing of the individual, family, and country.
PICO Model
The issue of depression can be addressed using the PICO model. PICO is an evidencebased model for framing a question, locating, evaluating, and repeating as needed. Elements of
PICO involve Problem/Patient/Population, Intervention, comparison, an outcome. PICO is
applied in evidence-based practice to frame a question, plan a search strategy, and filter evidence
(Eriksen & Frandsen, 2018). The four elements of PICO are discussed in relation to depression
in children below.
Population
The population element of PICO describes how the problem affects the patient population
(Eriksen & Frandsen, 2018). The main problem at hand is depression while the patient
population is children living in Los Angeles County. Depression is a major problem in Los
Angele County based on the high number of children that have reported being depressed, as well
as the high suicide rates in the population.
Intervention
The intervention element of PICO considers the prognostic factor or exposure under
consideration (Eriksen & Frandsen, 2018). The intervention being considered is pediatric
screening, where children are subjected to standardized tests that pinpoint to depression.
Depression does not have a single test, but rather, it involves a number of tests on the
individual’s conduct and behavior. Siu (2016) recommends undertaking pediatric screening for
major depressive disorder in children and adolescents. Screening should be conducted to ensure
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accurate diagnosis, effective treatment, and accurate follow-up. Screening and early detection of
depression in children leads to improved health outcomes.
Comparison Group
The comparison element of PICO considers a control group that can be used to compare
the outcome of administering the intervention versus not administering it (Eriksen & Frandsen,
2018). Comparison treatment for depression is no treatment at all. The proposed intervention for
addressing depression is pediatric screening. The comparison group will provide a basis for
determining the effectiveness of the intervention in early diagnosis and improving the child’s
physical and emotional development. This way, the comparison group will highlight any
differences between children that are administered pediatric testing for depression and children
that are not administered pediatric depression screening PHQ-2.
Outcome
The outcome element of PICO considers the desired effect of the intervention. The side
effect of the intervention is improved detection of depression in children (Eriksen & Frandsen,
2018). Administering pediatric depression screening should increase the number of children
early diagnosed with depression. Consequently, increased detection of depression in children
results in better physical and psychological health, for the long run.
The PICO question is: Does pediatric depression screening PHQ-2, result in improved
detection of depression among children?
Summary
Depression among children is an issue of concern due to its potential impact on their
health and wellbeing. Children who are depressed report reduced functionality, reduced energy,
lack of interest in social activities, and poor health and wellbeing. Depression strains the
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relationships between children and their peers, friends, and parents. It leads to high costs in
providing healthcare to the affected children. Therefore, it is important to address depression due
to its implications on the child, child’s family, and country. The PICO model is effective in
undertaking research on the problem, intervention, comparison, and outcome of pediatric
screening of depression.
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Chapter Two: Review of the Literature
Introduction
Depression among children has largely been unreported with the attention of the health
sector being focused on depression among adults, which is more prominent. Depression among
children has been linked to increased risks of suicidality affecting 2 to 3% of children aged six to
twelve and 8% among teenagers (Bardach et al., 2014). Depression has been linked to the death
of over 3000 children under the age of 18 years as noted by Bardach et al. (2014). The
correlation between suicide and depression makes this disorder of particular importance in that
suicide is the leading cause of premature death among persons between the ages of 10 and 24
years. Furthermore, depression affects about 11% of youths in the U.S (Bardach et al., 2014).
The high prevalence rate therefore identifies the significant of depression as a national and global
health issue.
Depression affects the wellbeing and development of children in addition to affecting
their ability to reach their potential. The paper below explores evidence from literature to support
interventions aimed at improving the diagnosis of this disorder. The paper will provide extensive
analysis of the credible literature in the field that informs the evidence based practice to be
adopted within the pediatric setting. The purpose of this paper is to provide evidence to support
the implementation of pediatric depression screening as a technique to improving the detection
of depression among children.
Methods
The methods section explores the strategies adopted in the evidence research process.
The section provides an in-depth insight into the sampling strategies used that entails the
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databases, the types of studied focused on, the restriction used and the key terms used in the
research. Additionally, the section explores the inclusion and the exclusion criteria.
Sampling Strategies
The database selected to aid in the research process is the EBSCOhost online research,
Science Direct and Academic Search Complete. These databases provided an extensive list of
studies on the topic of pediatric screening of depression within the pediatric setting. The
databases had the most recent articles in addition to providing full access to the required
materials. To ensure only recent articles were accessed the search parameters were changed to
ensure that only articles published in the last seven years that is from 2012 were presented.
Recent articles provide information that is applicable to the current healthcare practices and have
more credibility. Additionally the research parameters were changed to ensure only peerreviewed articles was selected. Peer-reviewed articles tend to be reliable and valid, as
professionals within the field have reviewed them. The quality and credibility of the articles
selected was therefore prioritized through ensuring that all articles were peer-reviewed.
Additionally empirical studies were another focus of the research process and this aimed at
ensuring all articles selected had an introduction, methodology, results and discussions. Finding
empirical studies was important as they included observed and measured phenomena as they
derive knowledge and findings from actual experiences rather than from theories. The key terms
used include “depression screening”, “pediatric depression screening” and “depression screening
in pediatric care”.
Criteria used
An inclusion and exclusion criteria was used to guide the research process. The first
inclusion criteria was on including all articles published between 2012 and 2019 with any
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articles falling before this time period being disregarded. All articles had to be empirical studies
and therefore had to have four main elements of an empirical research that is the introduction,
methodology, results and the discussions. Additionally, the articles to be included had to be peerreviewed in nature. Furthermore, all articles had to deal with depression screening among
children or adolescents. All articles whose study samples were adults were discarded.
Additionally the articles to be included had to be from a reputable journal to enhance their
credibility.
Findings
The section below explores the findings from the literature review. Two parts will be
covered under the section that is the general findings and the chosen intervention. The general
findings section explores all possible interventions evidenced in the literature that can address
the issue of depression while the second section explores the chosen intervention and the
findings.
General findings
The analysis of the literature highlighted various interventions that may be implemented
within the pediatric setting to address the problem of depression among children. The concept of
providing multi-disciplinary consultation is argued by Craighead (2013) as an effective approach
towards promoting effective diagnosis and treatment of depression among children. Craighead
(2013) argued that the multi-disciplinary perspective takes into considering all aspects of the life
of the child thus helping to pinpoint the underlying causes of the symptoms observed. Craighead
(2013) noted that the symptoms of depression are shared across other mental illnesses such as
physical illnesses and sleep disorders further highlighting the need to take an in-depth
assessment of all aspects of the child’s life. Thorough assessment of depression among children
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takes into consideration of the behavior and the performance of the child at school and at home,
social functioning, the child’s medical and social history as well as the individual or family
psychiatric history. Consultation with other professionals is essential to gaining different
perspectives of the child’s mental and psychological state thus informing a clear diagnosis.
Multi-disciplinary consultation in the diagnosis process is therefore an effective approach
towards gaining an objective diagnosis of depression in pediatric care (Craighead, 2013).
Further analysis of literature identifies the value of cognitive behavioral therapy in
addressing depression among children as stated by Michael, Huelsman and Crowley (2005).
Michael et al. (2005) argued that the use of cognitive behavioral therapy can help children
experiencing depression due to its ability to change the negative beliefs as well as thought
patterns that are associated with depression. The intervention is effective in increasing the
child’s awareness of the connections between thoughts, behaviors and feelings using fun games
and reinforcement that are appropriate for the child’s age level.
Furthermore, Michael et al. (2005) noted that that the application of cognitive behavioral
therapy is effective in creating opportunities that that reinforce success as a measures of
addressing the feelings of helplessness that are aligned with depression. The use of positive
consequences and rewards can be used to shape behaviors and to reward efforts, success, and this
is based on the operant conditioning theory (Craighead, 2013). The positive experiences that the
child undergoes can be used to challenge the negative beliefs that are held by the depressed
child. Craighead (2013) argued that techniques such as homework assignment and role-playing
might be used successfully with children with the aim of achieving the goals of the cognitive
behavioral therapeutic approach. This intervention is aimed at modifying cognitive distortions
and this involves inviting the child to look at their thinking patterns helping to identify their
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readiness for change in addition to identifying themes that link thoughts and thinking patterns
together (Craighead, 2013). Under this intervention the role of the physician is to modify
maladaptive behaviors into adaptive behaviors and this involves identifying satisfying as well as
pleasurable activities to the child and making them party of their daily plan, Additionally
teaching ways to cope with negative feelings and how to set goals that that improve happiness
and wellbeing are important aspects of this interventions. Additionally, the setting of daily plans
and actions that seek to regulate behaviors such as sleeping and eating are important in
addressing depression among children.
Another effective intervention to addressing child depression is the use of family
therapy that is aimed at addressing familial support for the child with the aim of resolving the
symptoms of depression. Mihalopoulos, Vos, Pirkis and Carter (2012) argued that the mental
state of the child could not be understood without taking into consideration the family context as
the family system affects how the child views and interacts with the world around them.
According to Mihalopoulos et al. (2012), the different family interventions all seek to understand
that the family members influence the family dynamics and therefore can affect the wellbeing of
the children within those families. The interventions that may be applied include brief education
interventions aimed at educating the family members on depression, its impact and the role of the
family system in maintain the problem and resolving it.
Another intervention that has been shared by Mihalopoulos et al. (2012) and Craighead
(2013) is pharmacology. Although many physicians frown upon the act or prescribing antidepressant medications to children and adolescent, the use of medication is effective at
addressing the symptoms of depression. The integration of pharmacology and family therapy is
noted by Mihalopoulos et al. (2012) as an effective intervention to addressing depression
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among children. Pharmacology is however noted to be used as a last resort when other
interventions have failed or when a child is exhibiting severe symptoms of depression that could
be alleviated through the use of antidepressant. According to Mihalopoulos et al. (2012) drug,
therapy should only be used in situations in which the symptoms present an obstacle to other use
of interventions and should be accompanied with close monitoring by a pediatrician.
Other interventions evidenced from the literature including helping the child to cope with
depression through various activities. Mihalopoulos et al. (2012) stated the importance of
encouraging children with depression to list out as well as prioritize the things that are bothering
them and work with the physician to problem solve how they can address these issues.
Mihalopoulos et al. (2012) further noted about the value of trying to identify the stressors or
situations that results in low mood in the life of the child and thus seek to avoid them or learn
how to effectively respond to these situations in a different way that does not generate the
negative feelings and perceptions. Mihalopoulos et al. (2012) further highlighted that recounting
positive events that have occurred throughout the day is yet another activity that can help the
child to cope with depression. Mihalopoulos et al. (2012) proposed other activities such as
journaling that could help adolescents to write down their concerns in addition to highlighting
the positive aspects of their life in addition to helping the child to identify supportive networks of
friends and family who may offer comfort when the child is feeling low.
Chosen intervention
The intervention chosen and supported by evidence-based research is the use of pediatric
screening to improve diagnosis of depression among children. The adoption of pediatric
screening as a technique to improving diagnosis of depression among children is supported by
the findings of the study by Allgaier et al. (2014). Screening tools are effective in aiding the
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diagnostic process and the ability of the screening tools to identify the probability of depressive
symptoms therefore informs the diagnosis of depression within the pediatric setting. The purpose
of Allgaier’s et al. (2014) research was to improve the early detection of childhood depression
with the Children’s Depression Screener (Child-S). The researcher sampled 79 children between
the age of nine and twelve. With majority of the children (74.7%) were outpatients (Allgaier et
al., 2014). Purposive sampling was used in the selection of the participants. Statistical analysis of
the data was carried out. The findings validated the use of the depression-screening tool within
pediatric care as it highlighted that 4.5% of the patients involved in the study suffered from
depressive symptoms. The diagnostic accuracy of the ChilD-S tool was found to be high with
an accuracy of 92% and therefore an effective tool to use in pediatric care (Allgaier et al., 2014).
The results of this study indicate that screening tools such as the ChilD-S is accurate and
effective at screening depression and thus informing the diagnosis of depression within the
pediatric setting. The results may indicate the credibility of pediatric screening to diagnosing
depression among children within the healthcare setting (Allgaier et al., 2014). The results
indicate that the implementation of screening tools that have been tested shows reliability and
validity of these tools and therefore lends its support to the adoption of screening tools to help
the physicians in diagnosing the prevalence of depression within the pediatric setting.
Pediatric screening as a technique to promote effective diagnosis of depression among
children is further supported by research based evidence gathered by Bhatta, Champion, Young
and Loika (2018). The purpose of the study by Bhatta et al. (2018) was to understand the
benefit of routinely implementing the Patient Health Questionnaire (PHQ-9) screening tool
among a group of 137 adolescents aged between 12 to 18 years of age to identify the level of
risk of developing major depressive disorders (Bhatta et al., 2018). A quantitative research
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methodology is evidenced in this study. The methodology adopted in this study was a
retrospective chart review of 256 cases with data analysis including descriptive statistical
methods (Bhatta et al., 2018). The results of the PHQ-9 depression screening tool identified that
56.3% of the participants were at risk of developing Major Depressive Disorder (Bhatta et al.,
2018). The effectiveness of this tool within the school-based pediatric setting identified the value
of adopting depression screening tools to aid in the diagnosis of depression among children. The
findings from the screening tool facilitated referrals to mental health practitioners therefore
improving morbidity and the mortality among the adolescent population. Pediatric screening is
evidenced as an affective technique to promoting the diagnosis of depression among children
based on the findings of this research study (Bhatta et al., 2018). With subtle symptoms of
depression being evidenced among children the implementation of pediatric screening is vital to
promoting the diagnosis of this disorder in addition to informing the necessary steps to be taken
such as the referral of the pediatric patients to mental health services.
The study by Esmaeeli et al. (2014) aimed at exploring the topic of depression in
hospitalized pediatric patients. Esmaeeli et al. (2014) noted that hospitalized children tend to
experience many mood changes and thus are at risk of developing depression. The researchers
adopted a quantitative research methodology. The researchers sampled 90 children between the
ages of 8 and 16 (Esmaeeli et al., 2014). The census sampling method was used while children
who had a history of depressive mental disorders being excluded from the research. The results
of the research showed that 63% of the participants had depression after being screened
(Esmaeeli et al., 2014). A significant statistical relationship between the severity of depression
and the duration of illness was evidenced with children who were hospitalized more than 3 times
a year being experiencing higher levels of depression. The research therefore highlighted that
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sufficient screening of depression be carried out among children hospitalized more than once as
it informs accurate medical diagnosis of mood disorder and depression therefor promoting early
treatment aimed at improving the quality of life as well as accelerating the treatment process of
the medical conditions (Esmaeeli et al., 2014). The research further provided insights into the
importance of screening as a tool for highlighting the mental state of the patient thus informing
the need for referral to pediatric psychologists capable of helping the child. Esmaeeli et al.
(2014) argued that screening of hospital pediatric patient helped in the identifying of depression
thus directing for further assessment to informing accurate diagnosis. With 63% of the pediatric
patients having some form of depression the study may highlight the critical nature of depression
within the pediatric setting and therefore the importance of depression screening among children
in this setting thus informing early diagnosis of the disorder.
The study by Siu (2016) highlights the value of screening children and adolescents for
Major Depressive Disorder. A systematic review of research articles on the topic was critical to
understanding the benefits and the harms of screening in addition to the feasibility of screening
tests. The participants involved in the studies were between the ages of 7 and 18 years. The
evidence of the benefits of screening identified the need to recommend depression screening for
adolescents aged 12 to 18 years of age. Screening as argued by Siu (2016) should be supported
by adequate systems that ensure that accurate diagnosis and effective treatment is achieved. The
researcher argued that screening tools would be effective in providing insights into the mental
state of children and adolescents within the primary care setting. The findings identify that
screening tools are effective in highlighting symptoms of depression among children as they
provided opportunities for early detection, intervention and treatment (Siu, 2016). Therefore the
benefits of screening as indicated by this research highlight the value of adopting specific
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PEDIATRIC DEPRESSION SCREENING
screening tools to support early diagnosis and intervention thus reducing the burden of
depression experienced by the children and their families.
The systematic review carried out by Thombs, Roseman and Kloda (2012) further
supports the view that pediatric screening is effective at informing depression diagnosis within
the pediatric setting. The researcher collected data from various articles from different
bibliographic databases such as MEDline, EMBASE, PyscINFO, Cochrane Central and Lilacs.
The studied analyzed involved children and adolescents between the ages of 6 to 18 years of age
(Thombs et al., 2012). The purpose of the research was to validate the use of screening as
possible solution to improving the diagnosis and the management of depression among children.
The research questions aimed to answer the accuracy of the depression screening tools and the
effectiveness of depression screening during childhood (Thombs et al., 2012). Additionally the
research study aimed to explore the potential benefits and harms associated with depression
screening. The results of the study points to the value of optimal depression management, which
can only be, achieve through screening and subsequent diagnosis of this disorder. Screening in
childhood is noted as an approach to help the health care providers in identifying patients and
providing depression management services and programs (Thombs et al., 2012). The results of
the article therefore indicate that screening would assist in highlighting symptoms of depression
thus informing diagnosis and the implementation of treatment interventions.
Discussion
This section tackles three main points that is the limitations, the general conclusions and
the potential project. The first section explores the limitations of the literature review process.
The second section briefly highlights the chosen intervention, how robust the evidence was, and
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PEDIATRIC DEPRESSION SCREENING
why it was chosen. The potential practice changes that are informed by the literature will be
explored.
Limitations
The literature was limited as few studies explored the outcomes of pediatric screening
which would have enhanced the supportive evidence of the intervention selected. Although the
literature explored the issue of depression screening among children, none was able to provide
substantive evidence to show the impact that depression-screening tools have on the patient
outcomes. Additionally most articles integrated into the literature review were quantitative in
nature and none had adopted a qualitative research methodology to promote further
understanding of the issue. Furthermore, generalizability of most articles include in the literature
review process did not take into account the ethnic and cultural backgrounds of the participants
and this creates the assumptions that depression screening does not differ regardless of
differences in race, gender, culture and ethnicity. Furthermore, validity and reliability of the
articles cannot be ascertained and this highlights a major limitation that affects then evidence
provided. Most of the quality articles were outdated and were therefore excluded from the
literature review, which handicaps the quality of the literature review. There is a need to expand
research into other databases to collect more extensive evidence to support the claims made in
this paper.
General conclusions
The chosen intervention was the use of pediatric screening in informing the diagnosis of
depression among children. The evidence was robust in that it helped to provide empirical
findings that were used to support the intervention. The evidence provided was robust as it was
derived from recent, peer-reviewed articles. The scholarly nature of the articles and the limited
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PEDIATRIC DEPRESSION SCREENING
bias evidenced from these research articles further highlights the strength of the evidence used to
support this intervention. Pediatric screening was chosen as a method to improve diagnosis of
depression, which has become a major problem within the American society. The high
prevalence rates of depression in the population especially among children and adolescents and
the adverse effects of depression of growth and development identify the importance of
screening and early detection and treatment of this disorder.
Potential project
The change of practice needed within the healthcare setting is the training of healthcare
providers in the pediatric setting to implement screening tools to all children and especially,
potential high-risk socio-economical risk factors of developing depression. The practice that
would change is the adoption of regular screening of children who are at risk of depression, to
screening all children as depression is masked differently by c various children relate dot their
background, ethnicity, gender or cultural beliefs. The healthcare providers will learn and adopt
various depression-screening tools such as the ChilD-S that helps in identifying symptoms of
depression informing the diagnosis and the treatment of this disorder.
Summary
Depression as a mental disorder affects the growth and development of children and
adolescents. The sampling strategies adopted such as setting year restrictions and seeking peer
reviewed articles only were aimed at collecting quality and credible evidence to support the
interventions. Inclusion criteria involved locating articles published after 2012 and empirical
research articles as well. The general findings highlight various interventions to address
depression and they are pharmacology and cognitive behavioral therapy. The chosen
intervention that will change practice is the adoption of pediatric screening in the diagnosis of
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PEDIATRIC DEPRESSION SCREENING
depression among children. The limitations of the literature review process is that few quality
articles were located, generalizability of the articles without consideration for ethnic and cultural
differences and lack of any qualitative research articles. The evidence provided to support the
intervention was strong as it was collected from peer-reviewed scholarly articles. The change of
practice expected is the adoption of depression screening tools among healthcare providers when
dealing with children who have a high risk of depression within the pediatric setting.
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References
Allgaier et al. (2014). Improving early detection of childhood depression in mental health
care: The Children ׳s Depression Screener (ChilD-S). Psychiatry research, 217(3), 248-252.
Bardach et al. (2014). Common and costly hospitalizations for pediatric mental health
disorders. Pediatrics, 133(4), 602-609.
Bhatta, S., Champion, J. D., Young, C., & Loika, E. (2018). Outcomes of depression
screening among adolescents accessing school-based pediatric primary care clinic services.
Journal of pediatric nursing, 38, 8-14.
Craighead, W. E. (2013). Interventions for childhood depression. Shanghai archives of
psychiatry, 25(1), 50.
Esmaeeli et al. (2014). Screening for Depression in Hospitalized Pediatric Patients.
Iranian Journal of Child Neurology, 8(1), 47–51.
Michael, K. D., Huelsman, T. J., & Crowley, S. L. (2005). Interventions for child and
adolescent depression: Do professional therapists produce better results?. Journal of Child and
Family Studies, 14(2), 223-236.
Mihalopoulos, C., Vos, T., Pirkis, J., & Carter, R. (2012). The population costeffectiveness of interventions designed to prevent childhood depression. Pediatrics, 129(3),
e723-e730.
Siu, A. L. (2016). Screening for depression in children and adolescents: US Preventive
Services Task Force recommendation statement. Annals of internal medicine, 164(5), 360-366.
Thombs, B. D., Roseman, M., & Kloda, L. A. (2012). Depression screening and mental
health outcomes in children and adolescents: a systematic review protocol. Systematic reviews,
1(1), 58.
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Chapter Three: Theory and Model for Evidence-based Practice
In healthcare, theoretical approaches are necessary to translate research into practice.
They also provide a greater understanding into the factors that impact implementation outcomes.
Therefore, evidence-based practices are useful in determining the efficacy of various initiatives
and their impact on healthcare outcomes. The use of evidence-based practice is crucial as it
ensures that nurses base healthcare practices on information grounded in research. Theories and
models when implementing healthcare interventions influence nurses. While theories are
analytical principles that structure observation, models are the guiding processes that translate
research into practice (Nilsen, 2015). Jean Watson’s theory of caring and the Ace-Star Model
will influence the implementation of the evidence-based practice.
Theory
Jean Watson’s theory of caring will guide the implementation of the evidence-based
practice. The theory focuses on the provision of empathetic care, where the nurse is responsible
for making a connection with patients to facilitate the healing process. Jean Watson developed
the theory of caring, which is discussed in her book “Philosophy and Science of Caring”. Watson
indicates that caring is crucial to nursing practice as it promotes healing. She indicates that
medical cure alone cannot to bring about healing, but that a holistic approach to healthcare needs
to facilitate improved health outcomes (Turkel, Watson, & Giovannoni, 2018). Watson believes
that a proactive caring attitude in the nursing profession substantially improves healthcare
outcomes.
The theory of caring is based on ten carative factors. The carative factors are underlying
principles of Jean Watson’s theory of caring. The first carative factor involves forming a
humanistic system of values. Nurses are required to care for themselves and for others. Caring is
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based on a philosophical, moral, and ethical foundation of love and values. The formation of
humanistic values considers the nurse’s experiences and skills to be integral to the practice of
nursing (Turkel, Watson, & Giovannoni, 2018). The experience that nurses have undergone in
their personal and professional lives shapes their behavior towards others. Nurses are supposed
to care for patients’ health and wellbeing. The figure below demonstrates Jean Watson’s ten
carative factors.
Figure 1: Jean Watson’s ten principles conceptualizing the theory of caring (Wills, 2011).
The second carative factor involves providing faith and hope to patients. Nurses provide a
sense of well-being for others. Patients battling illnesses may feel helpless and nurses are
required to provide them with hope that their health situations will improve. Pointing out
healthcare interventions that will improve the patients’ healthcare situation is one of the ways
through which nurses can provide faith and hope to patients. Nurses should also incorporate the
patients’ beliefs and values into the care plan to make them feel cared for (Watson & Brewer,
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2015). Nurses should also strive to create human connections by calling patients by viewing
them as human beings and encouraging them to go on with life. This way, nurses will have
supported the patients’ sense of self.
The third curative factor entails being sensitive to oneself and to others. Nurses are
required to empathize with the patients’ feelings. Nurses who empathize with others are more
authentic. As a result, the nurse and patient achieve self-growth and self-actualization. Being
sensitive to other people involves understanding their fears and concerns and responding in a
way that will solve the patients’ problems (Watson & Brewer, 2015). Nurses should transform
tasks into healing interventions. Rather than viewing their roles as providers of care, nurses
should recognize that they play an integral role in promoting the patients’ healing. The form of
interaction between nurses and patients largely contributes to healthcare outcomes.
The fourth factor involves developing a helping-trust relationship between nurses and
patients. The creation of trust between nurses and patients is crucial for positive health outcomes.
Nurses have to create an environment of trust to facilitate meaningful interactions with patients.
Without a trusting relationship, patients would be inclined to withhold information, which would
negatively impact the extent to which the patients’ healthcare needs are addressed (Watson &
Brewer, 2015). The helping-trust relationship is only possible when nurses seek to work from the
patient’s subjective perspective. Nurses should be non-judgmental to facilitate the creation of a
positive environment that leads patients to trust them.
For nurses to provide care, they have to promote and accept the patients’ negative and
positive feelings. Patients may demonstrate negative or positive feelings depending on what they
could be going through. Nurses are required to acknowledge patients’ feelings to show that they
understand the patients’ situations (Turkel, Watson, & Giovannoni, 2018). Nurses should be
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aware that healing is an inner journey and that patients should be provided with the right to
express themselves without judgment. Although patients may be pessimistic about their
healthcare situations, nurses should assist them to see good aspects of their situation.
Nurses are required to apply scientific methods of problem solving and decision making.
Before nurses can implement any healthcare interventions, they need to be certain of the
effectiveness in addressing various healthcare challenges. The demonstration of caring requires
nurses to implement interventions that have undergone scientific reviews that have determined
their effectiveness. Sinclair et al. (2016) indicate that applying healthcare interventions that are
verifiable scientifically ensures that nurses practice the ethical principle of beneficence, where
healthcare professionals are expected to provide healthcare interventions that promote the health
and wellbeing of patients.
The seventh carative factor entails promoting interpersonal teaching and learning. Nurses
should always embark on expanding the skills and expertise in addressing healthcare challenges.
Growth in skills and learning ensure that nurses implement healthcare interventions that promote
healthcare outcomes. Also, nurses should strive to impart their knowledge on patients and other
healthcare professionals to promote better techniques of providing care (Turkel, Watson, &
Giovannoni, 2018). Learning should be continuous to equip nurses with improved skills in
providing care.
Nurses are required to display caring by providing a supportive environment for patients’
physical, spiritual, mental, and socio-cultural needs. While addressing physical health is
important, addressing mental health is equally imperative as it affects an individual’s health and
wellbeing. Nurses should to take a holistic approach when addressing the patient’s health
condition. Other factors such as wholeness, comfort, and peace and dignity have are important
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when providing care (Watson & Brewer, 2015). Nurses should create healing environments that
anticipate and fulfill patients’ needs.
The provision of care requires nurses to satisfy human needs based on Maslow’s
hierarchy of needs. Each need is equally important in the promotion of the patient’s health.
Nurses should understand that different people have unique needs requiring different approaches
when delivering care. As a result, a patient’s unique needs such as their perceptions of the world,
their expectations of privacy, and their needs for comfort a patient’s determines the best
healthcare approach in addressing their needs (Watson & Brewer, 2015). Administering care
requires the nurse to be cognizant of the fact that patients may need varied levels of care.
The tenth carative factor involves the allowance of existential-phenomenological forces
that assist nurses in viewing patients holistically while addressing their hierarchical ordering of
needs. Nurses are required to consider the patients’ spiritual beliefs when providing care. They
should also take into consideration the patient’s existential beliefs and acknowledge that their
beliefs are important to them (Watson & Brewer, 2015). Thus, nurses should nurture and support
patients’ beliefs in hope and miracles. They should also respect things that have meanings to
others.
Application to practice change.
Jean Watson’s theory of care highlights the importance of supportive care for positive
health outcomes. The carative principle of providing hope and faith to patients can be used to
highlight the nurses’ role in facilitating the screening of pediatric patients. When patients screen
positive for depression, nurses should provide them with hope that their mental health conditions
can improve. The nurses’ referral of patients to mental health practitioners is one way through
which they will be providing hope and care.
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Jean Watson’s theory of care will have positive implications in the implementation of
depression screening at the hospital. Nurses have to convince patients on the importance of
carrying out depression screening. The results of the screening will rely on whether there is a
helping-trust relationship between the nurse and patient. The presence of a trusting environment
enables patients to be truthful when undergoing depression screening, as they will view the
nurses as being empathetic to their situation. Nurses can create a trusting relationship though
verbal and nonverbal communication (Brooks, Manias, & Bloomer, 2018). The use of verbal
communication would involve using language that is clear and articulates the nurse’s intention to
understand the patient. The use of nonverbal communication involves paying attention to
patients and being responsive to them.
The theory of care requires nurses to accept patients’ feelings, regardless of whether they
are negative or positive. When administering depression screening, nurses should provide a safe
place where patients can narrate their experiences. They should provide an environment for the
patients’ stories to emerge, grow, and develop. The theory of care assists nurses to encourage
patients to undergo reflections of their feelings and experiences (Watson & Brewer, 2015).
Patients can only provide accurate answers on the screening tool after they have clearly
evaluated their situations to determine the most appropriate response for each question.
The carative factor of using scientific methods of problem solving is particularly
important as it aligns with the depression screening initiative. The main aim of the intervention is
to determine whether training nurses in the administration of depression screening will improve
the health outcomes of pediatric patients with depression. The evidence-based activity aligns
with Jean Watson’s emphasis on the need of using scientific methods when providing care. The
evidence-based activity will provide information on whether training will promote the use of
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depression screening. Increased depression screenings will potentially result in an increase in the
number of pediatric patients that screen positive for depression (Forman-Hoffman et al, 2016).
Therefore, nurses will support the screening of all pediatric patients, as the intervention would be
effective.
Jean Watson’s theory has identified interpersonal teaching and learning as an important
principle when caring for patients. The evidence-based practice evaluates the importance of
learning in the healthcare outcomes of pediatric patients with depression. The principle of
learning will be applied through training nurses and equipping them with essential skills needed
to undertake depression screening. On the other hand, the principle of teaching will be enforced
through the interactions between nurses and patients, where nurses will impart information on
the importance of undertaking screening in addressing mental health issues.
Jean Watson’s caring theory can be applied holistically in the implementation of the
evidence-based practice. Nurses are required to engage their emotions in developing a caring
relationship with patients. The main aim of the evidence-based practice is addressing mental
health challenges affecting pediatric patients. For nurses to provide care, they have to create an
environment that facilitates trusting relationships with patients so that patients can divulge
information that will be necessary in determining the result of depression screening (Brooks,
Manias, & Bloomer, 2018). As a result, the theory of caring will facilitate the addressing of
patients’ mental health challenges.
Watson’s theory emphasizes the importance of creating a workplace environment that
promotes caring. Lachman (2016) indicates that nurses often work in environments that breed
frustrations, anger, and apathy. The negative feelings emanate from lack of environmental
support, as the nurses are not well equipped to handle healthcare challenges that they face on a
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day-to-day basis. Training nurses will equip them with the relevant skills needed to address
patients’ mental health challenges. The nurses will undergo training that will create an
environment for delivering effective nursing care. The application of Jean Watson’s theory of
care in the implementation of the depression screening evidence-based practice will be useful as
it will align research with practice.
Evidence-Based Practice Change Model
Nursing models are applied in determining how decisions are conceptualized to guide
decision-making. Evidence-based practice emanates from the integration of available research to
promote effective decision-making. The use of models in the implementation of evidence-based
practices enhances the effectiveness and efficacy of healthcare interventions. For evidence-based
practices to be successful and sustainable, a culture of readiness is facilitated through the
adoption of an implementation framework (Rousseau & Gunia, 2016). As a result, evidence
based practice models are useful in the translation of research into practice. Models play a
significant role in identifying the clinical problem, appraising evidence, appraising the need for
practice change, and evaluating outcomes. The Ace-star Model will be applied in providing a
framework for organizing evidence based practice processes.
The Ace-Star model was founded by faculty at the University of Texas Health Science
Center at Saint Antonio. The model contains five points of sequential knowledge transformation.
They comprise of discovery research, evidence summary, translation to guidelines, practice
integration, and process outcome evaluation (White & Spruce, 2015).
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The Ace-Star Model (White & Spruce, 2015).
The first stage of the Ace-Star model is known as discovery research. It is also known as
the knowledge-generating stage. The model involves the discovery of new knowledge through
traditional research methodologies and scientific enquiry. During the discovery research stage,
primary research activities may be carried out to gather information pertaining to the evidence
based practice (White & Spruce, 2015). For an evidence based activity to be reliable, it has to
produce similar results when replicated in another setting. As a result, the discovery research
method has to consider the validity and reliability of the results, as well as the replicability of the
activity.
The second stage of the Ace-Star model, the evidence summary step, entails the process
of synthesizing research knowledge into meaningful statements on the state of knowledge.
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Evidence summary processes differ in credibility, which in turn affects the reproducibility of
results. The evidence summary reduces large amounts of data into a manageable form. The
process involves determining the consistency of the data collected and explaining the reason for
data inconsistency. The evidence summary step also determines the cause and effect of a
relationship. The process also reduces bias from random and systematic errors and improves the
true reality of the situation. The evidence summary step takes into consideration the existing
information on clinical care and compares it with the findings of the evidence based practice
(Wilson et al., 2016). The results align with existing information to determine the importance of
policy formation.
The third stage of the Ace-Star model is the translation stage, and it entails transforming
evidence summaries into practice recommendations that can integrate into practice. The process
entails providing recommendations in form of care standards. The process involves establishing
clinical practice guidelines that support clinical decisions. Based on the evidence summaries,
healthcare organizations determine how they can implement various healthcare initiatives that
will improve healthcare outcomes (Wilson et al., 2016). Policy guidelines are helpful as they
establish standards of care followed by nurses when administering care. The translation stage
requires management support for establishing the guidelines and integrating them into standards
of care.
The fourth stage of the Ace-star model is the integration process. The process entails
making changes to the organization’s practices based on the new information. Healthcare
organizations are required to undergo continuous learning to facilitate the implementation of new
research into healthcare practices. Similarly, the information gained from the evidence-based
activity should make changes that will improve the delivery of care. The organization has to
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PEDIATRIC DEPRESSION SCREENING
create a conducive environment to facilitate the integration of new information (Wilson et al.,
2016). A positive environment of change facilitates the integration of the change into sustainable
systems.
The last stage of the Ace-Star model is identified as the evaluation stage. It is important
to assess the effectiveness of a healthcare initiative by ensuring that it has a positive impact on
health outcomes, efficiency, efficacy, cost, and health status. The evaluation sage involves
assessing whether the evidence based practice is effective in addressing the challenges meant to
be addressed. The evaluation stage is important as it critically examines the outcome of the
intervention (Wilson et al., 2016). If the outcome is not aligned with the objectives, adjustments
are made to ensure better outcomes. The process may be repeated with the new adjustments until
a favorable outcome is attained.
Application to practice change.
The first stage of the Ace-Star model will be applied through engaging in knowledge
gathering on the effectiveness of pediatric depression screening. Participants will be required to
undergo pretest screening to determine their knowledge on carrying out depression screening.
They will also be required to take a post-test to establish the number of screenings completed
during the implementation phase of the project. The pretests and posttests will be compared to
one month prior to determine any increase in the rate of screening, (b) age, gender and race of
those screened, (c) number of positive screens, (d) what follow-up occurred. If positive screens
are identified, a tally of the type of follow up will be kept. The first stage of the Ace-Star model
is crucial to the evidence-based practice as it will identify the clinical problem, and facilitate
knowledge gathering on the effectiveness of depression screening in resolving the problem of
mental health challenges among pediatric patients.
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PEDIATRIC DEPRESSION SCREENING
The second stage of the Ace-Star model, the evidence summary stage, focuses on
reviewing the results of the evidence based activity and summarizing them in a way that is
manageable and easy to understand (Indra, 2018). The collected data will be synthesized in a
manner that will allow for an understanding into the results of the study. Data will be
transformed into information by determining the results, comparing the results against the
existing body of knowledge, and highlighting any discrepancies in the data. The stage is crucial
to the pediatric depression screening stage as it will synthesize all the data collected during the
evidence-based project.
The third stage of the Ace-Star model, the translation stage will guide the implementation
of the recommendations identified by the evidence summary process. In the event that the
evidence summary process establishes the effectiveness and efficiency of screening tools in
addressing pediatric mental health, the healthcare organization will establish guidelines requiring
all pediatric patients to undergo depression screening. The guidelines will also establish training
protocols or nurses and other healthcare personnel in administering depression screening and
referring patients who have tested positive to mental health practitioners.
The fourth stage of the Ace-star model, the integration process, will be crucial to turning
research into practice. The results of the evidence-based practice will provide insight into the
changes needed to ensure that the healthcare organization provides effective and efficient
healthcare services. The management should be provided with the results of the evidence based
practice so that they can ascertain that providing training on depression screening tools translates
to better health outcomes (Wilson et al., 2016). As a result, the management will be responsible
for implementing actionable steps that will ensure that the changes are merge with organizational
processes. For instance, the management can set up guidelines requiring all pediatric patients to
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undergo depression screening. When the recommendation is set up as a guideline, it will be more
effective as the healthcare staff will enforce it.
While leadership will play an important role in the integration process, staff participation
will also play a crucial role as healthcare providers will be required to facilitate the change
process. At the conclusion of the project, an internal meeting will be held to discuss the impact
of the program. All interested parties employed at the facility will be invited to attend. The
meeting will discuss the impact of the program in facilitating best practices for assessment of
screening for depression in pediatric patients. Discussions will involve sustainability measures
for the new practice. It will be an interactive session where participants provide their views on
the impact of the project on depression screening and treatment at the facility.
The inclusion of the staff will enhance the rate of success in implementing the change
initiative. Employees are more inclined to support a change initiative if they are involved in its
implementation (Byron et al., 2015). Undoubtedly, requiring nurses to undergo training on the
administration of depression screening tools will lead to major organizational changes due to
adjustments in nurses’ duties and responsibilities. For the healthcare staff to support the new
initiative, they have to have assurance that the new guidelines will not negatively affect their
performance.
The evaluation stage of the Ace-Star model is useful in ensuring that the intervention
recommended by the evidence-based program has attained its intended objectives (Byron et al.,
2015). The implementation of the depression screening evidence based program is intended to
showcase that increased training results in an increase in the number of depression screenings
that are conducted, which in turn improves the mental health statuses of pediatric patients
diagnosed with depression. Although the evidence based practice may have determined
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depression screening as having a positive impact in addressing the mental health challenges
faced by pediatric patients, the claim needs validation in a real-life setting.
Key performance indicators such as number of patients undergoing depression screening,
number of positive screenings, the number of pediatric patients referred to mental health experts,
and the overall impact in improving health outcomes. The healthcare facility has to examine the
number of patients that have undergone depression screening after the implementation of the
intervention. An increase in the number of patients undergoing screening is a demonstration that
training has been effective in informing nurses on the importance of conducting depression
screening among all pediatric patients. Evaluation will also entail assessing the number of
screenings that have provided positive outcomes. An increase in positive results will demonstrate
that the intervention has been effective in identifying pediatric patients who could be having
depression.
In addition, evaluations have to determine the impact of the intervention in improving
healthcare outcomes. It may be challenging to determine the exact impact of the screening in
determining healthcare outcomes, but one way implementing it is by assessing the number of
individuals who underwent depression screening and given referrals to mental health experts. An
increase in referrals to mental health experts is an indication that the patients’ mental health
needs are ben addressed. When the patients successfully undergo treatment for depression, their
overall health outcomes will improve. Therefore, the evaluation of the impact of the evidencebased practice in healthcare needs to examine the number of patients that have successfully
undergone treatment for depression.
Summary
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The use of the theory and model in the implementation of the evidence-based
practice will enhance the success of the project in addressing healthcare challenges. The theory
of caring will influence the nurses’ perception of the evidence based practice (Turkel, Watson, &
Giovannoni, 2018). Nurses will be required to change how they carry out their duties, and it is
likely that they may fail to support the project if it significantly interferes with their duties.
Nonetheless, the theory of caring will present the evidence based practice as an intervention with
potentially positive results in addressing depression in pediatric patients.
The Ace-Star model will determine how the organization can shift research into practice.
Undertaking organizational change could be problematic without a framework for establish
guidelines and influencing decision-making. The Ace-Star model contains five stages that are
effective in ensuing that the organization successfully implements depression screening (Wills,
2011). The model addresses the responsibility of the nurses in undergoing training and ensuring
the screening of all pediatric patients. The model is also effective in highlighting the
management’s responsibility in change implementation. The management is responsible for
setting rules and guidelines or the staff as well as evaluating the intervention to determine its
effectiveness in improving health outcomes. The combination of the theory of caring and the
Ace-Star model will enhance effectiveness in the implementation of the evidence-based practice.
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Chapter Four: Pre-implementation Planning
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Project Purpose
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Project Management
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Organizational readiness for change. Start typing here…
Inter-professional collaboration. Start typing here…
Risk management assessment. Start typing here…
Organizational approval process. Start typing here…
Use of information technology. Start typing here…
Materials Needed for Project
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Plans for Institutional Review Board Approval
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Plan for Project Evaluation
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Plan for demographic data collection. Start typing here…
Plan for outcome data collection and measurement. Start typing here…
Plan for evaluation tool. Start typing here…
Plan for data analysis. Start typing here…
Plan for data management. Start typing here…
Summary
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Chapter Five: Implementation Process
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Setting
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Participants
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Recruitment
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Implementation Process
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Plan Variation (If Applicable)
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Summary
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Chapter Six: Evaluation and Outcomes of the Practice Change
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Participant Demographics
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Outcome Findings
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Outcome one. Start typing here…
Outcome two. Start typing here… if there is more than one outcome
Summary
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Chapter Seven: Discussion
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Recommendations for Site to Sustain Change
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Plans for Dissemination of Project
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Project Links to Health Promotion/Population Health
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Role of DNP-Prepared Nurse Leader in EBP
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Future Projects Related to Problem
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Implications for Policy and Advocacy at All Levels
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Summary
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Chapter Eight: Final Conclusions
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Clinical Problem
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Evidence Base
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Theory and Model for Evidence-Based Practice
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Project Management
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Project Implementation
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Outcome Findings
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Discussion Summary
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Final Conclusions
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Appendix A
Appendix Title Here
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Appendix B
Appendix title here
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Appendix C
Appendix title here
Running head: PEDIATRIC DEPRESSION SCREENING
Appendix D
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Appendix E
Appendix title here
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Appendix F
Appendix title here
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Appendix G
Appendix title here
Purchase answer to see full
attachment