Engaging Older Adults in a Depression Simulation Experience.

BACKGROUND: Clinical simulation has become integral to curriculum development in nursing programs. This innovative intervention was designed to explore the efficacy of high-fidelity standardized patient (SP) simulation to increase students' ability to recognize signs of depression and to improve therapeutic communication. METHOD: During a 12-month period, prelicensure nursing students (n = 136) in a midwestern nursing program participated in this simulation experience. Volunteer retirees residing in the college-affiliated retirement village played the roles of depressed patients. RESULTS: Students' self-evaluations indicated this experience was a positive learning experience. All of the students indicated the experience improved their knowledge about depression; 91% stated their confidence in interviewing improved, and 89.7% indicated improvement in their communication skills. CONCLUSION: Use of SP simulation in mental health nursing is an effective strategy to bolster confidence, improve depression screening skills, and enhance therapeutic communication skills. [J Nurs Educ. 2022;61(4):209-212.].

Conditions that influence a primary care clinician's decision to refer patients for depression care.

The objective of this study was to identify conditions that influence primary care clinicians' referral decisions related to depression care. Forty primary care clinicians (15 general internists, 10 nurse practitioners, and 15 family practice physicians) were included in this study. The clinicians participated in semistructured interviews and completed two quantitative instruments (with 33 items on depression treatment decision making and 32 items on provider attitudes toward psychosocial care). Data analysis revealed that several conditions influence a clinician's decision to refer a depressed patient to a mental health specialist: the patient's resources, the clinician's comfort in prescribing antidepressants and counseling patients with depression, and familiarity with a mental health specialist and practice environment. The decision to refer a patient with depression to a mental health specialist is a complex process involving the clinician, patient, and practice-related issues. Understanding these relationships may provide strategies to improve depression care management and lead to the design of depression care quality-improvement interventions that accommodate primary care practice context. The findings from this study suggest a need to increase mental health training opportunities for primary care clinicians to strengthen their skills and comfort level in managing depressed patients and encourage the development of relationships between primary care clinicians and mental health specialists to facilitate timely and accessible mental health care for patients.

Reinvention of depression instruments by primary care clinicians.

PURPOSE: Despite the sophisticated development of depression instruments during the past 4 decades, the critical topic of how primary care clinicians actually use those instruments in their day-to-day practice has not been investigated. We wanted to understand how primary care clinicians use depression instruments, for what purposes, and the conditions that influence their use. METHODS: Grounded theory method was used to guide data collection and analysis. We conducted 70 individual interviews and 3 focus groups (n = 24) with a purposeful sample of 70 primary care clinicians (family physicians, general internists, and nurse practitioners) from 52 offices. Investigators' field notes on office practice environments complemented individual interviews. RESULTS: The clinicians described occasional use of depression instruments but reported they did not routinely use them to aid depression diagnosis or management; the clinicians reportedly used them primarily to enhance patients' acceptance of the diagnosis when they anticipated or encountered resistance to the diagnosis. Three conditions promoted or reduced use of these instruments for different purposes: the extent of competing demands for the clinician's time, the lack of objective evidence of depression, and the clinician's familiarity with the patient. No differences among the 3 clinician groups were found for these 3 conditions. CONCLUSIONS: Depression instruments are reinvented by primary care clinicians in their real-world primary care practice. Although depression instruments were originally conceptualized for screening, diagnosing, or facilitating the management of depression, our study suggests that the real-world practice context influences their use to aid shared decision making-primarily to suggest, tell, or convince patients to accept the diagnosis of depression.