Assignment 3: Identify a Gap in Practice

Practice focus question Would the development of a practice guideline that offers a systematic approach to screening, using the PHQ-A result in increased guidance and willingness and ability of providers to screen teens for depression in the practice setting?

During these weeks of the course, you identified a problem in your organization. In your Discussion, you examined this problem with your colleagues. Now, it is time to present this identified gap in practice to your Instructor.

To Prepare
• Review the Learning Resources covering problem identification.
• Identify a gap in practice or needed practice change at your practicum.
• Work with your preceptor to explore the gap in practice or practice change for you to lead.

The Assignment:
Working with your preceptor, identify a gap in practice or a practice change that you can help address by leading multiple activities in the organization toward the change throughout the duration of your practicum experience.
During the clinical hours required in this practicum course, you may pursue activities within this course that support your DNP project, such as meeting with the team and stakeholders to improve problem identification and/or conducting discussions with the team about literature search and critique.

Resources
Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.
• Chapter 4, “The Practice Question Phase” (pp. 73–98)
Hickey, J. V., & Giardino, E. R. (Eds.). (2021). Evaluation of quality in health care for DNPs (3rd ed.). Springer Publishing.
• Chapter 1, “Evaluation and Advanced Nursing Practice: The Mandate for Evaluation” (pp. 3–36)

Agency for Healthcare Research and Quality. (2017). Action plan for translating research into practice: Gap analysis and tests of change: Facilitator guide.
https://www.ahrq.gov/hai/tools/mvp/modules/cusp/action-plan-trip-fac-guide.html

Gallagher Ford, L., & Melnyk, B. M. (2019). The underappreciated and misunderstood PICOT question: A critical step in the EBP process. Worldviews on Evidence-Based Nursing, 16(6), 422–423. https://doi.org/10.1111/wvn.12408

Shirey, M. R. (2011). Addressing strategy execution challenges to lead sustainable change. JONA: The Journal of Nursing Administration, 41(1), 1–4. https://doi.org/10.1097/NNA.0b013e318200288a

Stannard, D. (2021). Problem identification: The first step in evidence‐based practice. AORN Journal, 113(4), 377–378. https://doi.org/10.1002/aorn.13359

Twa, M. D. (2016). Evidence-based clinical practice: Asking focused questions (PICO). Optometry and Vision Science, 93(10), 1187–1188. https://doi.org/10.1097/OPX.0000000000001006

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Solution

Identification of a Gap in Practice: Screening for Depression and Suicidality in Adolescents Using the Patient Health Questionnaire Modified for Adolescents (PHQ-A)

Gap analysis means determining the disparity between present healthcare service realities or practices and the anticipated or expected best practice. It essentially highlights the gap between existing performance levels and patient expectations (Unruh & Hofler, 2016). When it comes to healthcare as a service, a gap develops when the perception of the service obtained in the healthcare facility differs from the intended service. The purpose of this paper is to present an identified gap concerning adolescent mental health. Adolescent depression and suicidality arising from it is a major public health concern.

Evidence-Based Practice (EBP)

The identification of a gap in practice is facilitated by the process of clinical inquiry. This involves the formulation of a PICOT question and then researching evidence from published scholarly literature to support the best evidence-based practice (EBP) that addresses the question (Melnyk & Fineout-Overholt, 2019; Stannard, 2021; Twa, 2016). One of the EBP recommendations that was found to address the gap discovered in this case was early screening of depression and potential for suicidality among adolescents.

Practice Problem Identified

The practice problem that formed the basis for the PICOT question was that of rampant prevalence of depression among adolescents. Because adolescents are at a stage in their lives at which they are discovering themselves and transiting to adulthood, they face numerous challenges. These are the challenges that predispose them to depression and suicidal ideation. According to scholarly evidence, between 10% and 15% of all adolescents will suffer depression at some time in their lives. Indeed, the authors state that screening for depression among adolescents at any given time will show that at minimum 5% of them are depressed (Young et al., 2010). Some of the reasons behind these figures include negative peer pressure, pressure from school in terms of academic work, teenage pregnancies, drug and substance use, and lack of parental guidance amongst others.

The Identified Gap in Practice

Following the clinical inquiry with the PICOT question, it was discovered that one of the best ways to handle the matter of adolescent depression and suicidality is to prevent it. However, prevention depends heavily on identifying the adolescents who are at risk of developing depression and those who are yet to manifest observable symptoms. What this means therefore is that screening for depression is the only way to determine this. Unfortunately, in current practice it was discovered that there is very little depression screening that is happening amongst adolescents. This is the major gap in practice that was identified.

The recommendation is that screening for adolescent depression be done by practitioners such as psychiatric-mental health nurse practitioners (PMHNP) using the Patient Health Questionnaire Modified for Adolescents or PHQ-A (Johnson, 2002). The choice of this assessment tool was informed by the fact that it is specifically tailored to assess the severity of depression among adolescents. The teenagers who will be of concern with this test are those that will score 10-14 (moderate depression, 15-19 (moderately severe depression), and 20-27 (severe depression). Henceforth, screening for depression among adolescents should be standard evidence-based practice.

Conclusion

In clinical practice, there are many practice gaps that can only be identified using clinical inquiry into common practices. One of these is the lack of use of screening tools that can identify teenagers who are at risk of developing depression. This is important because it is only by doing that that it can be possible to take action early. The consequences of depression among teenagers are dire and include suicidality.

References

Johnson, J. (2002). PHQ-9 modified for adolescents. https://missionhealth.org/wp-content/uploads/2018/04/Adolescent-Depression-Screening-PHQ-A-Form.pdf

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.

Stannard, D. (2021). Problem identification: The first step in evidence‐based practice. AORN Journal, 113(4), 377–378. https://doi.org/10.1002/aorn.13359

Twa, M.D. (2016). Evidence-based clinical practice: Asking focused questions (PICO). Optometry and Vision Science, 93(10), 1187–1188. https://doi.org/10.1097/OPX.0000000000001006

Unruh, L., & Hofler, R. (2016). Predictors of gaps in patient safety and quality in U.S. hospitals. Health Services Research, 51(6), 2258-2281. https://doi.org/10.1111/1475-6773.12468

Young, J.F., Miller, M.R., & Khan, N. (2010). Screening and managing depression in adolescents. Adolescent Health, Medicine, and Therapeutics, 1, 87-95. https://doi.org/10.2147/AHMT.S7539

 

 

 

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