Roles of Nurses in Depression Management in Primary Care Settings

Monday, 12 July 2010: 3:05 PM

Linda Rose, PhD, RN
School of Nursing, Johns Hopkins University, Baltimore, MD

Learning Objective 1: 1. identify barriers to effective nurse based management of depression in primary care settings

Learning Objective 2: 2. describe potential and actual nursing roles in interevning with patients with depression in primary care.

Purpose: Many patients seek help for depression at primary care settings but are not adequately treated. Nurses in these settings are most often the teachers of illness management knowledge and skills to patients and their families.  Patients’ depression is important in primary care because it may interfere with adherence to treatment and increase the risk for developing or worsening medical disorders.  Currently little is unknown about how nurses, physicians and patients think about depression in primary care settings and their roles in treatment.  The aims of the study were to: 1) explore attitudes, beliefs and experiences of health care providers (HCPs) in primary care settings about depression in patients, roles of HCPs in depression care, and effects of depression on families; 2) explore patients’ and HCPs attitudes about including families in depression care; and 3) identify knowledge and attitudes of HCPs about depression treatment, and barriers to providing depression care in primary care settings.
Methods: .  Indepth semi-structured interviews were conducted with HCPs and patients with depression at 4 primary care sites in an urban setting.  Semi-structured interviews with 15 HCPs and 5 patients were completed. Interviews were 35 minutes to an hour. Interviews were analyzed using thematic analysis. Transcribed interviews were coded using the NVIVO computer program. 
Results: Results indicated that there were differences in attitudes and beliefs of APNs and baccalaureate/ associate degree nurses toward depression treatment. System based factors influenced HCPs’ responses to patients with depression, including barriers and facilitators to effective treatment for depression. Patients’ described experiences with depression as a factor affecting their co-occurring medical conditions.
Conclusion: Results add to understanding of factors that, if addressed, may meet the mental health needs of this population. Interventions based on this study should be tested to determine if they enhance patient management of depression over time.