Student Name Chamberlain University NR-505: Advanced Research Methods: Evidence-Based Practice Prof. Name Date Week 7: Evidence-Based Practice Project Proposal Assignment Purpose This assignment represents the culmination of the evidence-based practice (EBP) change proposal. Using the Evidence-Based Practice Project Proposal Template, students will integrate essential components to form a comprehensive proposal. Key elements include identifying relevant stakeholders, explaining data collection and analysis strategies, and highlighting anticipated outcomes in connection with the chosen nursing practice issue and PICOT question. The goal of this assignment is to apply evidence-based principles to nursing practice by linking theoretical knowledge, research findings, and practical application. Course Outcomes This assignment enables the student to demonstrate mastery of the following course outcomes (COs): Due Date Description of the Assignment Students will complete the Evidence-Based Practice Change Project Proposal Template. The proposal must cover the following areas: This process ensures that students can logically and systematically design an evidence-based change project applicable to their nursing specialty. Criteria for Content The proposal should include the following sections: Nursing Practice Issue/Problem PICOT Question Stakeholders Theoretical Framework Literature Review Data Collection Methods Data Analysis Expected Outcomes Preparing the Assignment Students are expected to: Assignment Criteria and Grading Below is the grading rubric presented in table format: Criteria Points Description Practice Problem, PICOT, Stakeholders 40 – Describe the area of interest and nursing problem.- Identify MSN Specialty Track.- Provide problem background.- Identify stakeholders.- Restate PICOT question.- Integrate scholarly sources. Theoretical Framework & Literature Review 50 – Explain the guiding theoretical framework.- Summarize literature and themes from Week 5 Research Table.- Provide sufficient scholarly support. Data Collection, Analysis, Expected Outcomes 40 – Describe methods of data collection.- Explain data analysis.- Identify expected outcomes.- Support with scholarly sources. Graduate-Level Writing Style 20 – Correct spelling, grammar, and punctuation.- Clear organization and logical flow.- Professional and scholarly tone.- Limited direct quotes (≤15 words).- Correct APA format. Total 150 100% Rubric Levels of Achievement Each grading criterion will be evaluated on the following scale: References American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). APA. Dang, D., & Dearholt, S. L. (2017). Johns Hopkins nursing evidence-based practice: Model and guidelines (3rd ed.). Sigma Theta Tau International. NR 505 Week 7 Evidence-Based Practice Project Proposal Outline Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

Student Name Chamberlain University NR-505: Advanced Research Methods: Evidence-Based Practice Prof. Name Date Week 6 Reflection on Learning: NR 505 This week’s engagement with the CITI training course provided valuable insights into the ethical responsibilities of healthcare professionals, particularly when working with vulnerable populations. The content highlighted how these groups can be at risk of exploitation if appropriate safeguards are not in place. As a nursing professional, this reflection emphasized the importance of maintaining vigilance and ensuring that ethical standards guide all aspects of care and research. Moreover, I recognized the critical role of nurse practitioners as advocates. Beyond clinical practice, they must protect the rights of patients and research participants, serving as both caregivers and ethical leaders. The American Nurses Association (ANA) Code of Ethics and the Collaborative Institutional Training Initiative (CITI) principles both stress a commitment to moral practice, sensitivity, and respect for human dignity. By integrating these standards, nurses can better align patient care with ethical principles that address prevention, treatment, and recovery. The Role of Ethics in Nursing and Research The principles of ethics extend beyond patient interactions into research practices. The CITI course underscored the idea that healthcare professionals are not only providers of care but also resources for research participants. This includes ensuring informed consent, protecting confidentiality, and minimizing potential harm. The ANA and CITI frameworks collectively reinforce that ethical behavior should be the foundation of every professional action. NR 505 Week 6 Reflection on Learning The following table summarizes the main connections between the ANA Code of Ethics and the CITI training principles in relation to nursing practice: Ethical Framework Focus Areas Implications for Nursing Practice ANA Code of Ethics Patient advocacy, moral integrity, respect for autonomy Encourages nurses to safeguard patient rights, uphold professional standards, and deliver compassionate care. CITI Principles Protection of research participants, sensitivity to vulnerable groups, informed consent Guides nurses in conducting ethical research and ensuring participants are fully protected. Reflection on Advocacy How do nurses ensure ethical practice in patient care and research? Nurses ensure ethical practice by adhering to both the ANA Code of Ethics and the guidelines provided by training programs such as CITI. This involves being attentive to patient vulnerabilities, respecting individual autonomy, and maintaining professional accountability. Why is advocacy central to the nursing role? Advocacy is central because it ensures that patients’ voices are heard and their rights safeguarded, particularly when they are unable to speak for themselves. Advocacy aligns with the nursing responsibility to reduce suffering and promote well-being. Application to Professional Growth Engaging with these ethical principles not only strengthens clinical decision-making but also enhances professional integrity. For example, incorporating awareness of potential vulnerabilities during both care and research ensures a patient-centered approach. Additionally, understanding ethics through both ANA and CITI perspectives prepares nurses to address real-world challenges such as balancing patient autonomy with safety and navigating informed consent in complex care situations. By applying these ethical insights, nurse practitioners can contribute to more equitable care delivery, stronger patient-provider trust, and a healthcare system that prioritizes dignity and recovery. References American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association. Collaborative Institutional Training Initiative. (n.d.). CITI Program training courses. Retrieved from https://about.citiprogram.org/ NR 505 Week 6 Reflection on Learning Grace, P. J. (2018). Nursing ethics and professional responsibility in advanced practice (3rd ed.). Jones & Bartlett Learning. Ulrich, C. M., Grady, C., & Danis, M. (2020). Ethics in nursing research. American Journal of Nursing, 120(6), 50–54. https://doi.org/10.1097/01.NAJ.0000669745.16610.e7

Student Name Chamberlain University NR-505: Advanced Research Methods: Evidence-Based Practice Prof. Name Date PICOT Question In young children from birth to five years old, does early education about healthy eating and exercise provided to both parents and the child, compared to education offered only to parents before the child’s birth, lead to healthier weight outcomes as measured during routine well-child visits over a five-year period? Article 1 Full Reference Sjunnestrand, M., Nordin, K., Eli, K., Nowicka, P., & Ek, A. (2019, November 9). Planting a seed—Child health care nurses’ perceptions of speaking to parents about overweight and obesity: A qualitative study within the STOP project. BMC Public Health. https://doi.org/10.1186/s12889-019-7852-4 Purpose The study explored how child health care (CHC) nurses perceive their responsibilities in childhood obesity prevention, particularly focusing on how they communicate with parents regarding weight concerns. Evidence Type Qualitative study Sample, Sample Size, and Setting The participants were CHC nurses practicing in Stockholm County. Out of 442 invited nurses, a selected group was interviewed. Data Collection Information was gathered using semi-structured interviews conducted both face-to-face and via telephone. Study Findings Two main themes were identified: (1) building trust and rapport with parents is fundamental when discussing sensitive weight-related topics, and (2) systemic barriers, such as lack of resources, impede effective intervention and support. Limitations The research was limited to a single geographic area and lacked detailed exploration of long-term child health outcomes. Relevance to PICOT and Implications for Advanced Nursing Practice The findings emphasize the importance of relational communication in weight management. For PICOT, this underscores how involving both parents and children in ongoing education can enhance trust and collaboration in preventive care. Advanced practice nurses should prioritize relationship-building to encourage early adoption of healthy behaviors. Article 2 Full Reference Sastre, L. R., Matson, S., Gruber, K. J., & Halderman, L. (2019, February 28). A qualitative study examining medical provider advice, barriers, and perceived effectiveness in addressing childhood obesity to patients and families from a low-income community health clinic. SAGE Open Medicine. https://doi.org/10.1177/2050312119834117 Purpose The purpose of this study was to examine medical providers’ perspectives on addressing childhood obesity in low-income, ethnically diverse communities and to understand the challenges they encounter in counseling families. Evidence Type Qualitative study Sample, Sample Size, and Setting The research was conducted in three community health clinics serving predominantly low-income families. Collectively, these clinics provided care to around 56,000 patients annually, with previous data showing 43% of children (n = 2951) were overweight or obese. Data Collection Provider interviews were analyzed using content analysis and open coding methods, focusing on themes related to initiating weight discussions, counseling techniques, and barriers encountered. Study Findings Providers generally felt comfortable beginning weight-related discussions as early as age two. Counseling often emphasized physical activity, while nutritional guidance was less prominent. Parents and the home environment were identified as central influences on children’s health behaviors. Barriers to effective care included cultural differences, parental resistance, time limitations, and language barriers. Limitations The study highlighted challenges but did not offer concrete solutions to overcome systemic barriers. Relevance to PICOT and Implications for Advanced Nursing Practice For PICOT, this reinforces the importance of engaging both children and parents in early education to overcome resistance and ensure sustainable outcomes. Advanced practice nurses should employ culturally competent, family-centered strategies to address obesity prevention effectively. Article 3 Full Reference Hagman, E., Danielsson, P., Brandt, L., Svensson, V., Ekbom, A., & Marcus, C. (2017, July 8). Childhood obesity, obesity treatment outcome, and achieved education: A prospective cohort study. Journal of Adolescent Health. https://doi.org/10.1016/j.jadohealth.2017.05.008 Purpose This study investigated the relationship between childhood obesity, educational attainment, and whether obesity treatment improved both health and academic outcomes. Evidence Type Mixed methods (quantitative, observational cohort design) Sample, Sample Size, and Setting The sample consisted of 1,465 participants registered in the Swedish Childhood Obesity Treatment Registry. Data Collection Longitudinal data were collected prospectively and compared with national educational statistics to identify correlations. Study Findings The research showed that children with obesity often had lower educational achievement in early adulthood. Participation in obesity treatment programs not only improved weight-related outcomes but also positively influenced academic attainment. Limitations The findings may not be generalizable outside Sweden due to demographic and cultural differences. Relevance to PICOT and Implications for Advanced Nursing Practice The study illustrates that interventions addressing obesity during childhood may have long-term benefits extending beyond health, such as improved educational outcomes. For PICOT, this highlights the potential broader societal benefits of early obesity education for children and parents. Article 4 Full Reference Isong, I. A., Rao, S. R., Bind, M.-A., Avendaño, M., Kawachi, I., & Richmond, T. K. (2018, January 1). Racial and ethnic disparities in early childhood obesity. Pediatrics, 141(1), e20170865. https://doi.org/10.1542/peds.2017-0865 Purpose The research examined racial and ethnic disparities in childhood obesity and identified socioeconomic and behavioral risk factors that contribute to these inequalities. Evidence Type Longitudinal study Sample, Sample Size, and Setting Data were derived from 10,700 participants in the Early Childhood Longitudinal Study Birth Cohort (ECLS-B). Data Collection Blinder-Oaxaca decomposition analyses were used to assess how different socioeconomic and behavioral variables influenced BMI disparities across racial and ethnic groups. Study Findings The study revealed substantial variations in obesity prevalence across racial and ethnic groups. African American children had the highest obesity rates, while Asian children had the lowest. Socioeconomic disadvantage and maternal influences were strong predictors of childhood obesity. Limitations Reliance on some self-reported data could limit accuracy. Relevance to PICOT and Implications for Advanced Nursing Practice For PICOT, this highlights the need for culturally tailored approaches in early education to effectively reduce disparities. Advanced practice nurses should design prevention programs that address unique community and cultural needs. Article 5 Full Reference Salvy, S.-J., de la Haye, K., Galama, T., & Goran, M. I. (2016, December 2). Home visitation programs: An untapped opportunity for the delivery of early childhood obesity prevention. Obesity Reviews, 18(2), 149–163. https://doi.org/10.1111/obr.12482 Purpose The article proposed using home visitation programs as a proactive method of preventing childhood obesity from infancy through early development. Evidence Type Conceptual/theoretical review Sample, Sample Size, and Setting Not

Student Name Chamberlain University NR-505: Advanced Research Methods: Evidence-Based Practice Prof. Name Date Week 4 During this week, I gained deeper insights into qualitative research and its specific role in nursing practice. Unlike quantitative research, which relies heavily on numerical data and statistical analysis, qualitative research focuses on personal experiences, perceptions, and motivations. It is usually conducted in natural settings, allowing researchers to explore real-life situations and gather rich, descriptive data. Findings in qualitative research are primarily expressed in words rather than numbers, which provides a more detailed understanding of participants’ perspectives. At first, identifying an appropriate qualitative article was challenging. However, using the CINAHL database with full-text access helped expand my search and refine the results. Additionally, the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Appendix E appraisal tool served as a practical guide. It provided step-by-step support in distinguishing qualitative studies from other forms of research. Initially, I reviewed several articles, but I chose one that explicitly mentioned “qualitative descriptive study” in its title. Even then, I carefully read the full article to confirm its methodology. This approach allowed me to verify that the study aligned with the qualitative framework. Is the Study Appropriate? Yes, the study is appropriate. It examines patients’ experiences and perceptions regarding the use of resources in pressure ulcer prevention. By exploring how patients perceive the appropriateness of different interventions based on their conditions, the study effectively highlights patient-centered perspectives. Can a Similar Study Be Conducted in Different Settings? Yes, a similar study could be replicated in more complex healthcare environments. For example, instead of focusing only on pressure ulcer prevention, researchers might explore patient perceptions of fall prevention strategies, wound care management, or chronic illness support programs. Each adaptation would provide valuable insights into how patients experience and respond to care in different contexts. Comparison of Research Designs Each research design—qualitative, quantitative, and mixed methods—serves a distinct purpose. They differ in terms of sample selection, data collection, and analysis techniques. For instance, qualitative studies rely on interviews, focus groups, or observations, while quantitative studies often depend on surveys, experiments, and statistical testing. Mixed-methods research integrates both approaches, allowing for a more comprehensive understanding. Below is a table highlighting the differences: Table 1 Comparison of Research Designs NR 505 Week 4 Reflection Research Design Purpose Data Collection Methods Data Representation Strengths Limitations Qualitative Explore experiences, perceptions, and meanings Interviews, focus groups, observations Words, narratives, themes Rich, detailed insights; patient-centered Limited generalizability; time-consuming Quantitative Measure variables, test hypotheses, and identify patterns Surveys, experiments, structured tools Numbers, statistics High generalizability; objective results Lacks depth of individual experience Mixed-Methods Combine qualitative and quantitative insights for broader understanding Both interviews and surveys/experiments Words + Numbers Comprehensive results; balances perspectives Requires more time, resources, and expertise Personal Preference Having explored qualitative, quantitative, and mixed-method designs in weeks 3 and 4, I find that a mixed-method approach is the most beneficial. It combines the richness of patient experiences with the generalizability of numerical data. For instance, using qualitative interviews can capture patients’ emotional responses to interventions, while quantitative surveys can provide statistical evidence of effectiveness. This dual approach ensures that both subjective and objective elements are considered, resulting in stronger, more reliable findings. References Johns Hopkins Medicine. (2022). Johns Hopkins Nursing Evidence-Based Practice: Model and guidelines (4th ed.). Sigma Theta Tau International. Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer. NR 505 Week 4 Reflection Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). Sage publications.

Student Name Chamberlain University NR-505: Advanced Research Methods: Evidence-Based Practice Prof. Name Date Week 3: Collaboration Café Article Title Are the studies on cancer risk from CT scans biased by indication? Elements of answer from a large-scale cohort study in FranceBritish Journal of Cancer Purpose For this week’s assignment, I selected the article cited above because it closely relates to my PICOT question. The goal of this task is to critically appraise the study, evaluate its strengths and limitations, and consider its implications for practice. My PICOT question is: In children and young adults, does using a reduced radiation dose in computed tomography (CT) scans lower the lifetime risk of cancer compared to higher-dose exposure? This French cohort study employed a quantitative design to analyze how CT radiation exposure during childhood and adolescence influences the risk of developing cancer. Specifically, the researchers examined whether cumulative radiation exposure from CT scans was associated with increased cancer diagnoses, while also accounting for cancer predisposing factors. Research Design The study utilized a quantitative cohort design, which emphasizes numerical data collection and statistical analysis. Quantitative research is beneficial when examining relationships between variables within a defined population. In this study, the focus was on identifying whether CT exposure correlates with cancer incidence in children. The large sample size strengthened the validity of the design, as it enabled more robust statistical conclusions. Discussion of Sample The study population was selected using non-probability sampling. This method allowed researchers to focus on children who met specific inclusion criteria, such as age, timing of first CT scan, and absence of prior cancer diagnosis. Details of the sample are summarized below: Sample Characteristics Description Population Size 67,274 children Inclusion Criteria Born after January 1, 1995; first CT scan before age 10 between 2000–2010; no cancer diagnosis at first scan Sampling Method Non-probability sampling Rationale for Sampling Quick, inexpensive, and convenient for targeted populations (Elfil & Negida, 2017) Limitation of Method Potential bias due to lack of representativeness of the general population (Elfil & Negida, 2017) While non-probability sampling was practical and cost-efficient, it introduced potential concerns regarding representativeness, which may affect generalizability. Description of Data Collection Methods Data collection occurred across 21 French university hospitals and 23 radiology departments with pediatric populations. Several systems were used to gather and verify exposure and diagnostic information: The data included cumulative X-ray doses, patient demographics, and anatomical areas scanned. Children were followed from the date of their first CT until December 2011, cancer diagnosis, death, or their 15th birthday—whichever occurred first. Summary of Findings The study sought to evaluate whether CT scan exposure in childhood increased cancer risk. Over a four-year observation period: Although results indicated potential associations between CT exposure and cancer diagnoses, the relatively short four-year follow-up limited the ability to draw definitive conclusions. The authors emphasized that longer follow-up would be necessary to better assess radiation-induced cancer risks. Strengths of the Study Although explicit strengths were not outlined in the article, the study demonstrated several notable advantages: These strengths contributed to the reliability of the results and the potential applicability in pediatric radiology. Limitations of the Study The study presented key limitations, particularly related to indication bias. For example, CT scans may have been conducted in children already at risk for cancer, either to rule out malignancies or monitor predisposing conditions. Without detailed information on the reasons for scans, separating cancer risks from pre-existing conditions was difficult. The authors also noted that limited follow-up time reduced the ability to evaluate long-term cancer outcomes. Addressing these issues would require more extensive data on cancer-predisposing factors and longer tracking of participants (Journy et al., 2015). NR 505 Week 3 Collaboration Cafe Recommendations for Future Practice The authors and subsequent literature suggest several recommendations for practice: By incorporating these recommendations, healthcare professionals can ensure safer diagnostic practices for pediatric and adolescent populations. References Elfil, M., & Negida, A. (2017). Sampling methods in clinical research: An educational review. Journal of Advanced Practice Oncology, 5(1), 2107. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325924/ NR 505 Week 3 Collaboration Cafe Journy, N., Rehel, J. L., Pointe, D. L., Lee, C., Brisse, H., Chateil, J. F., Caer-Lorho, S., Laurier, D., & Bernier, M. O. (2015). Are the studies on cancer risk from CT scans biased by indication? Elements of answer from a large-scale cohort study in France. British Journal of Cancer, 112(1), 185–193. https://www.nature.com/articles/bjc2014526

Student Name Chamberlain University NR-505: Advanced Research Methods: Evidence-Based Practice Prof. Name Date NR 505 Week 2 PICOT Worksheet Assignment Identification of the Practice Issue My MSN specialty track is Nurse Executive, which emphasizes equipping healthcare teams with the competencies and resources necessary to provide safe, high-quality, and evidence-based patient care. A pressing health issue that I selected for my PICOT question is the global challenge of influenza. Despite being preventable through vaccines, influenza continues to affect millions of individuals worldwide and remains a significant public health concern. Even though influenza vaccines are readily available each year, many people either refuse or neglect to get vaccinated, leading to elevated infection rates and preventable hospitalizations. According to the Centers for Disease Control and Prevention (CDC, 2022), influenza affects an estimated 41 million Americans annually, causing approximately 140,000 hospitalizations and over 120,000 deaths. Vulnerable populations such as young children, pregnant women, older adults, and individuals with chronic illnesses bear the highest risk of severe complications. Evidence-based studies have consistently shown that vaccination is one of the most effective methods of reducing both the incidence and severity of influenza. Research confirms that vaccines not only protect the individual but also provide community-wide benefits by reducing transmission (Godoy et al., 2018). Therefore, addressing vaccine hesitancy and improving vaccination coverage remains a key public health priority. Significance of the Practice Issue Nurses consistently rank as the most trusted healthcare professionals due to their close, ongoing interactions with patients. This trust positions them as central advocates in promoting public health interventions, including influenza vaccination campaigns. Nurses are instrumental in: Importantly, effective nurse–patient communication is key to reducing vaccine hesitancy. Patients who receive thorough explanations from nurses about how influenza vaccination prevents severe illness are more likely to make informed, positive decisions about immunization (Keske et al., 2020). By increasing influenza vaccination uptake, nurses not only protect at-risk populations but also advance broader healthcare goals, including reducing preventable suffering, improving population health, and alleviating pressure on healthcare systems. Discussion of the PICOT Elements The PICOT framework helps organize the clinical question in a systematic way: PICOT Element Description P (Population) Young adults aged 18–30 years who have not received the influenza vaccine. This group plays a role in transmitting the virus to high-risk populations such as children, older adults, and individuals with chronic conditions. I (Intervention) Administration of the annual influenza vaccine to increase vaccination rates in this population. C (Comparison) Comparing rates of influenza-related morbidity between vaccinated and unvaccinated young adults during peak flu season. O (Outcome) Reduction in influenza infection and morbidity rates among vaccinated individuals aged 18–30 compared to their unvaccinated counterparts. T (Timeframe) A period of 6–8 weeks during the peak influenza season, with non-probability sampling applied to select participants. PICOT Statement (Narrative) In young adults aged 18–30 years, does receiving the influenza vaccine, compared to those who remain unvaccinated, reduce morbidity rates during the peak flu season when guided and supported by nurses? References Centers for Disease Control and Prevention (CDC). (2022). Disease burden of flu. https://www.cdc.gov/flu/about/burden/index.html Godoy, P., Romero, A., Soldevila, N., Torner, N., Jané, M., Martínez, A., … & Domínguez, A. (2018). Influenza vaccine effectiveness in reducing severe outcomes over six influenza seasons, a case-case analysis, Spain, 2010/11 to 2015/16. Eurosurveillance, 23(43), 1700732. https://doi.org/10.2807/1560-7917.ES.2018.23.43.1700732 NR 505 Week 2 PICOT Worksheet Assignment Keske, Ş., Mutters, N. T., Tsioutis, C., & Ergönül, Ö. (2020). Influenza vaccination among infection control teams: A EUCIC survey prior to COVID-19 pandemic. Vaccine, 38(52), 8357-8361. https://doi.org/10.1016/j.vaccine.2020.11.003 Roberts, D. (2018). Influenza vaccines: How effective are they? Evidently Cochrane. https://www.evidentlycochrane.net/influenza-vaccines-how-effective-are-they

Student Name Chamberlain University NR-505: Advanced Research Methods: Evidence-Based Practice Prof. Name Date Week 1: Area of Interest in Nurse Practitioner (NP) Practice Selected Area of Interest An important issue within nurse practitioner (NP) practice that captures my interest is the mental health of patients in primary care settings, particularly in the areas of depression and anxiety screening. Despite mental health concerns being highly prevalent, they often remain underdiagnosed or untreated. Research shows that more than 17.3 million adults in the United States experience depression annually, representing approximately 7.1% of the adult population (National Institute of Mental Health [NIMH], 2017). Unfortunately, stigma and misconceptions regarding mental health continue to prevent individuals from seeking help or accepting screenings (Aci et al., 2018). I recommend implementing routine annual depression and anxiety screenings for all patients during primary care visits. By adopting this practice, nurse practitioners can proactively identify individuals at risk, initiate timely interventions, and enhance overall treatment outcomes. Routine screening will not only improve patient health but also promote holistic, evidence-based care that addresses both physical and mental well-being. Relevance and Proposed Change Mental health challenges such as depression and anxiety have profound effects on patients’ quality of life, occupational functioning, and even mortality risks. Evidence indicates that primary care settings are optimal environments for implementing early mental health screening and intervention strategies (Geyti et al., 2018). If nurse practitioners incorporate standardized tools, such as the Patient Health Questionnaire (PHQ-9) for adults and the PHQ-A for adolescents, it will provide measurable and reliable data for timely diagnosis. Integrating evidence-based practice into primary care allows for more comprehensive treatment, reduces suicide rates, and increases patient satisfaction. Furthermore, the application of such screening demonstrates a provider’s commitment to individualized, patient-centered care (Chamberlain University, 2021). Table 1 Proposed Change: Routine Mental Health Screening in Primary Care Aspect Details Issue of Interest Depression and anxiety in community and primary care populations Target Population Adults (18+) and adolescents (12–17 years) Screening Tools PHQ-9 (adults), PHQ-A (adolescents) Frequency of Screening At least once annually during primary care visits Expected Outcomes Earlier diagnosis, improved treatment initiation, reduced suicide rates, enhanced patient/provider satisfaction Evidence Base Supported by studies on effectiveness of screening in primary care (Geyti et al., 2018; NIMH, 2017) Response 1 How Would I Implement This Intervention? If I were to implement routine depression and anxiety screening, I would use validated tools such as the PHQ-9 for adults and the PHQ-A for adolescents (ages 12–17). A score of 10 or higher would be considered a positive screen, prompting further evaluation and discussion of treatment options. Each patient would undergo screening annually, and outcomes would be tracked by recording both positive and negative results. Importantly, documentation would highlight patients diagnosed for the first time without prior history, enabling early intervention. For those who screen positive, follow-up care plans—including therapy, medication, or referrals—would be developed on the same day as the screening (Savoy, 2016). Measuring Outcomes To measure effectiveness, I would maintain records of: Continuous monitoring and follow-up would ensure ongoing evaluation of patient progress and effectiveness of interventions (Maurer et al., 2018). Table 2 Implementation and Outcome Tracking Implementation Strategy Outcome Measures Annual screenings using PHQ-9 / PHQ-A Number of screenings conducted Positive score ≥10 Percentage of patients screening positive Same-day documentation and care plan New diagnoses identified and interventions initiated Follow-up plans (therapy/medications) Patient adherence and progress documented at subsequent visits Response 2 Shauna,Your insights about the importance of addressing mental health in children and adolescents are significant. I completely agree that mental health challenges in youth are frequently underestimated or overlooked. Many parents assume that children do not face real struggles, yet societal pressures, academic demands, extracurricular activities, and social expectations place tremendous stress on them. In the United States, approximately 10.3% of children are diagnosed with depression or anxiety, and these rates continue to rise as expectations increase (Centers for Disease Control and Prevention [CDC], 2021). Unfortunately, many children and adolescents mask their emotions, making it difficult to detect their struggles until symptoms become severe. I strongly believe that children and adolescents should undergo annual depression and anxiety screenings, whether or not they exhibit symptoms. Routine screening during school physicals or primary care visits would ensure early identification and support, preventing worsening of mental health issues. Thank you for sharing your valuable perspective! References Aci, M., Zhang, S., Chomanczuk, A. H., O’Brian, K. H., De Zitella, M. L. M., Scrifanim, P. R., Velez, L., Garay, E., Sezer, S., Little, V., Cleek, A., & McKay, M. M. (2018). Barriers and facilitators to mental health screening efforts for families in pediatric primary care. Journal of Family Social Work, 21(3), 191–199. https://doi.org/10.1080/10522158.2018.1429212 Centers for Disease Control and Prevention. (2021). Data and statistics on children’s mental health. https://www.cdc.gov/childrensmentalhealth/data.html NR 505 Week 1 Area of Interest in NP Chamberlain University. (2021, September 1). Week 1 lesson: Evidence-based practice [Lecture notes]. https://chamberlain.instructure.com/courses/87542/pages/week-1-research-evidence-based-practice-and-quality-improvement?module_item_id=12780895 Geyti, C., Dalsgaard, E., Sandbæk, A., Maindal, H. T., & Christensen, K. P. (2018). Initiation and cessation of mental healthcare after mental health screening in primary care: A prospective cohort study. BMC Family Practice, 19(1), 1–9. https://doi.org/10.1186/s12875-018-0864-9 Maurer, M. M., Raymond, T. J., & Davis, B. N. (2018). Depression: Screening and diagnosis. American Family Physician, 98(8), 508–515. National Institute of Mental Health. (2017). Major depression. https://www.nimh.nih.gov/health/statistics/major-depression NR 505 Week 1 Area of Interest in NP Savoy, M. (2016). Screening your adult patients for depression. Family Practice Management, 23(2), 16–20.