Date of Conferral

2-10-2026

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Anna Hubbard

Abstract

This Doctor of Nursing practice (DNP) project was a quality improvement initiative focused on staff education to standardize the workflow and documentation of the Hamilton depression rating scale (HAM-D). The goal was to enhance measurement-based care and mitigate inconsistencies in depression severity assessments that could potentially delay treatment modifications, follow-up planning, and safety decisions. The practice-focused inquiry examined whether a concise staff education program, in conjunction with a HAM-D clinical practice guideline, would enhance staff knowledge and preparedness to administer and document the HAM-D for routine severity monitoring in adults exhibiting depressive symptoms. Employing rapid-cycle plan–do–study–act (PDSA) methodologies, five members of the primary care team underwent training on standardized administration/scoring anchors, considerations related to version measurement, interpretation of severity and changes over time, documentation requirements (total score, severity category, change, and plan), and protocol-based escalation procedures when suicidal ideation is reported, including a brief safety assessment. Outcomes were assessed using a five-item pretest and a corresponding five-item posttest, analyzed through descriptive statistics; mean scores increased from 2.8/5 (56%) to 4.8/5 (96%) (N = 5), signifying a heightened readiness to utilize HAM-D results in clinical actions and safety protocols. The primary deliverables included the draft HAM-D Clinical Practice Guideline/Screening Protocol and the Staff Training Outline/Materials. In summary, the project enhances nursing practice by refining severity monitoring, improving documentation quality, and facilitating care planning. The project has potential to enhance timely identification of severe symptoms for all patients.

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