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Depression is a common mental health condition that has a negative impact on people’s quality of life. The adverse effects are specifically pronounced in post-stroke older patients whose health can deteriorate considerably within a short period of time (Lim et al., 2019). It has been estimated that almost 800,000 people residing in the United States have a stroke each year, and over 240,000 experience depression (Rogers, 2017). Depression screening has proved to be an effective instrument to detect the problem early and develop an operational treatment plan in a timely manner (McIntosh, 2017). Nevertheless, the relevance of this procedure is often undermined in the acute clinical setting, and nursing professionals often fail to implement it properly (Trotta et al., 2018). Numerous challenges to the successful implementation of depression screening in the acute setting can be found. The major barriers include the lack of resources, the absence of clear protocols and tools, and insufficient preparedness of the personnel. A sound policy can address the issue and improve the quality of care provided to older patients.
Therefore, a new policy that could be applied on the state level should attend to such aspects as screening tools, staff training, and resources. Regarding the screening tools, a substantial bulk of research on the matter is available (McIntosh, 2017; Rogers, 2017). For instance, Trotta et al. (2018) noted that the Comprehensive Geriatric Assessment (CGA) model could be utilized to assess the overall state of the target population. However, this approach is not widely used to evaluate the mental health state with a focus on depression in the clinical setting. A common method employed in the acute clinical environment to identify depression levels is the Patient Health Questionnaire-9 (McIntosh, 2017). McIntosh (2017) examined the effectiveness of the Evidence-Based Depression Screening and Treatment (EBDST) protocol based on the use of PHQ-9 and found that the model improved the quality of care significantly. Depression screening was instrumental in identifying and managing depression symptoms in hospitalized patients with acute stroke.
A considerable amount of evidence supporting such claims is provided (McIntosh, 2017; Rogers, 2017). Hence, it is possible to develop a policy recommending the use of the PHQ-9, such as the EBDST, in the acute setting. Nursing practitioners will obtain clear guidance to assess older patients’ depression status. Nevertheless, more research in this field is needed since some studies show a limited efficacy of PHQ. For example, Shankar et al. (2017) and Trotter et al. (2019) stated that more research is necessary to identify all possible challenges to the effective implementation of the PHQ tool. Thus, the new policy should encompass the development of the platform for data dissemination as healthcare facilities should be encouraged to share their experiences, which will eventually lead to the creation of the instrument that can be utilized in diverse settings across the state.
The new policy should also address the aspects related to staff training to ensure the effectiveness of the protocol implementation. Administrators should be responsible for the provision of the corresponding training to nursing professionals, which will involve proper instructing, guiding, assessing, staffing, scheduling, and reimbursement. It can be beneficial to introduce certain assessments and self-reporting (or another form of feedback) aimed at evaluating the cost-efficiency of the training program. Again, the knowledge-sharing platform mentioned above can serve as an important source of data for the successful execution of the program.
Finally, the lack of resources is a common barrier to the implementation of policies and the overall provision of high-quality care. The new policy should encompass the information regarding available resources, as well as the channels to access them. The government should allocate some funds from the state budget to facilitate the appropriate use of depression screening models. It is also important to create a clear set of standards and measures utilized to distribute these funds. One of the criteria to consider when providing resources can be the engagement of the healthcare facility in the program. The knowledge-sharing platform can be used to identify the level of involvement of each facility. The hospitals that will be willing to access resources may be encouraged to conduct peer assessment, such as audit depression screening in other facilities (the ones that use their own funds to implement the policy). It is also essential to make sure that the benefits and peculiarities of the incentive are effectively communicated to the stakeholders, which will have a positive impact on their motivation and commitment to the established objectives.
In conclusion, it is possible to note that depression screening among geriatric patients in acute settings faces several challenges. A new policy should address these barriers by regulating the provision of resources, guidance in choosing the most efficacious protocols and approaches, as well as assistance in staff training. The introduction and implementation of the new strategy should not be presented as a new regulation. It has to become a new standard positively perceived by healthcare professionals who can abide by the new norm and improve the quality of care they provide. The development of the data-sharing platform and appropriate coverage of the new initiative can be instrumental in achieving this goal.
References
Lim, S. H., Ang, S. Y., Abu Bakar Aloweni, F. B., & Østbye, T. (2019). An integrative review on screening for frailty in acute care: Accuracy, barriers to implementation and adoption strategies.Geriatric Nursing, 40(6), 603-613. Web.
McIntosh, C. (2017). A depression screening protocol for patients with acute stroke. Journal of Neuroscience Nursing, 49(1), 39-48. Web.
Rogers, S. C. (2017). Poststroke depression screening. Journal of Neuroscience Nursing, 49(2), 66-68. Web.
Shankar, L., Smith, N., Uchino, K., Thompson, N. R., Pozuelo, L., & Katzan, I. L. (2017). Evaluation of the Patient Health Questionnaire-2 as a screening tool for depression during the acute stroke admission.Journal of Stroke and Cerebrovascular Diseases, 26(11), 2519-2526. Web.
Trotta, R. L., Rao, A. D., Hermann, R. M., & Boltz, M. P. (2018). Development of a comprehensive geriatric assessment led by geriatric nurse consultants: A feasibility study. Journal of Gerontological Nursing, 44(12), 25-34. Web.
Trotter, T. L., Denny, D. L., & Evanson, T. A. (2019). Reliability and validity of the Patient Health Questionnaire-9 as a screening tool for poststroke depression. Journal of Neuroscience Nursing, 51(3), 147-152. Web.
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