EVIDENCE-BASED PRACTICE PROJECT PROPOSAL OUTLINE



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Running Head: EVIDENCE-BASED PRACTICE PROJECT PROPOSAL OUTLINE

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EVIDENCE-BASED PRACTICE PROJECT PROPOSAL OUTLINE

Evidence-Based Practice Project Proposal Outline

Raven Jinks

Chamberlain University

NR 505: Advanced Research Methods: Evidence-Based Practice

October 20, 2019

Evidence-Based Practice Project Proposal Outline

Nursing Practice Concern/Problem

My APN specialty track is Family Nurse Practitioner (FNP). Healthcare providers are concerned about the adverse impacts of postpartum depression on the mother and the baby. The problem is that many new mothers are unable to identify PPD symptoms early on, thus predisposing them to the condition.

PICOT Question

In expectant and new mothers during pregnancy, how does screening for postpartum depression during and after pregnancy reduce the occurrence of postpartum depression during the postpartum period, compared to women who are not screened?

Key Stakeholders

1. Quality Improvement Director: Involved in approving quality improvement initiatives.

2. Mental Health Director: Crucial stakeholder responsible for the implementation of valid screening tools including, PHQ-9 (Patient Health Questionnaire-9) and EPDS (Edinburgh Postnatal Depression Scale).

3. Finance Director: Responsible for providing funds necessary for implementing the practice-change project.

4. Maternity Nurse Manager: Responsible for ensuring compliance in the maternity department, including organizing training for nurses to acquire screening skills.

5. Health Information Management System (HIMS) Director: Personnel responsible for the addition of medical records related to PPD screening

6. Director of ICT: Responsible for the implementation of an on-line-screening model

Theoretical Framework

The most appropriate model of change is based on Kurt Lewin’s change theory. The framework involves three stages including, the unfreezing phase, change phase, and refreezing phase, and it is based on the dominant resistant forces and the driving forces (Murphy, Pearsall, & French, 2016). When implementing PPD screening, the driving forces consist of nurses, who, as change agents, push the initiative towards change. However, some change agents will resist change, possibly fearing that they will get overworked. By understanding the forces, it is possible to strengthen the driving forces and diminish the resisting forces. For instance, all employees to be affected by the change may require training to understand the challenges that the current practice poses to health outcomes (unfreezing stage). The training will prepare them adequately for the change phase. The refreezing phase will be composed of stabilizing the new implementations.

Literature Review

According to Yawn et al. (2015), PPD screening helps to identify depressive symptoms early enough and provide adequate intervention. PPD occurrence in a new mother is impacted by psychological, socio-economic, and cultural factors (Chi et al., 2016). Research indicates that supporting new mothers to breastfeed and care for their babies during postpartum decreases the odds of depression. Those screened and found to be predisposed to PPD can access crucial medical and non-medical interventions before the illness escalates. However, health-care providers must implement effective screening models such as on-line screening, and they must consider the cultural backgrounds of the women to be tested.

Data Collection Methods

1. Interviews with expectant women and new mothers

2. Questionnaires to be filled in regards to depressive symptoms

· Quality of Life Enjoyment and Satisfaction Questionnaire

· Patient Health Questionnaire-9

· Activity Impairment Questionnaire

3. Medical records will collect crucial data about delivery, screening, treatments.

Analysis

There will be data analysis to determine the health outcomes of the women and in extension, provide insights into the importance of screening for PDD. The data collected will be put into the Outcome Measures Framework (OMF) that is standardized for depression. OMF for depressive conditions categorizes and calculates annual measures such as the all-cause mortality, death from suicide, clinical response, suicide behavior, quality of life, productivity, and medical-care resource utilization (Gliklich, Leavy, & Li, 2019). The average score determines the improvement of a depressive disorder such as PPD.

Expected Outcomes

Within 3-6months and 12months:

1. Work Productivity should improve after the screening.

2. Psychotherapy and other resource utilization should increase after screenings

3. Quality of life should increase

4. Depressive episodes months after screening and intervention should decrease

5. All-cause mortality and death from suicide should be zero

References

Chi, X., Zhang, P., Wu, H., & Wang, J. (2016). Screening for Postpartum Depression and Associated Factors Among Women in China: A Cross-Sectional Study. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2016.01668

Gliklich, R., Leavy, M., & Li, F. (2019). Standardized library of depression outcome measures. Agency for Healthcare Research and Quality. Retrieved from https://effectivehealthcare.ahrq.gov/products/library-depression/white-paper

Lean’s System Approach for change. OJIN: The Online Journal of Issues in Nursing, 21(2)4. DOI: 10.3912/OJIN.Vol21No02Man04

Yawn, B., Bertram, S., Kurland, M., & Wollan, P. (2015). Repeated depression screening during the first postpartum year. Annals of Medicine. DOI: 10.1370/afm.1777


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