The practice issue
Depressive disorders are rather prevalent in the older population (from 15 to 20% of them are reported to experience major depressive disorder). However, depression is difficult to diagnose and manage the population due to the increased possibility of comorbidities and worsened health. The proposed study intends to implement standard guidelines at a community clinic to better inform the activities of its nursing staff with respect to the issue.
Identification of the practice issue
The issue refers to inefficient clinical practices, which is the result of the differences in practice between the community clinic and standards. Also, the project is concerned with the quality of care and patient safety: it is vital to diagnose and manage depression appropriately; otherwise, it can have detrimental effects on the health and quality of life of patients and poses a risk of suicide.
The scope of the problem
The problem of inefficient practices is technically that of the institution, although the older population, individual patients, and their families also experience its consequences. In particular, depression can result in multiple negative effects on various aspects of life and is correlated with increased suicide risks, which is why the diagnosis and treatment of depression are crucial for patients’ safety and life quality. Thus, the problem can be viewed as a multi-scope one.
PICOT Elements
Population: the nursing staff of the clinic in question.
Intervention: the introduction of standard guidelines on diagnosing and managing depression in the older population (more than 65 years old).
Comparison: the performance of the nurses prior to the introduction of the new guidelines, which is more feasible and topical than benchmarking (that would require a longitudinal study).
Outcome: the changes in the accuracy and quality of diagnosing and managing depression in the older population; the desired outcome is the improvement of these parameters.
Timeframe: 8-10 weeks.
Evidence that must be gathered
Multiple sources of evidence are of importance, but the key ones include the standards that are going to be implemented as well as supporting guidelines. Apart from that, systematic literature reviews and clinical expertise will help in the process of establishing and implementing the standards: they can provide some evidence on the effectiveness of the guidelines, the topic, and related interventions, which will inform the change and convince the staff that it is necessary.
The PICOT question in narrow manageable terms
In community clinic nursing staff, how does the introduction of standard guidelines within eight weeks affects the accuracy and quality of diagnosing and treating depression in the older population as compared to the staff’s performance before the intervention?