Nurses' Knowledge and Beliefs Related to Depression and Screening in Heart Failure Patients

Purpose:   The purpose of this study was to assess nurses’ knowledge and beliefs related to depression and the use of screening in heart failure patients. To date, there has been no literature on this topic. It was the intent of this study to explore the likelihood that increased knowledge and nurses’ underlying foundational beliefs would result in a greater commitment to routinely screen heart failure patients for depression.

Methods: A descriptive design was used. This quantitative study used a one-group pretest, posttest, intervention design. The approach involved administration of an identical group pretest, educational intervention and posttest. The study utilized a purposive sample of registered nurses working full time, part time, and PRN (per diem) on adult medical-surgical units at a large urban teaching hospital in southeast Texas. Exclusion criteria included licensed vocational nurses and agency nurses. Data were collected using the Revised Depression Attitude Questionnaire. This questionnaire consisted of 20 questions eliciting responses according to a five-point Likert scale format representing answers ranging from strongly agree to strongly disagree. Five questions were added to capture additional information regarding intent to screen for depression in heart failure patients. A demographic questionnaire was used to capture relevant data such as age, gender, highest degree attained, years of experience as a registered nurse, current employment status and years worked at the facility where the study was conducted. Data was collected using SurveyMonkey.com. The institution’s IRB granted approval to conduct the study at this institution. For data analysis, surveys were coded and transferred to SPSS 20.0. Cronbach’s alpha was used to ensure validity and reliability. A paired t-test was used because of the pretest/posttest modality.

Results: Research Question #1: Will nurses’ knowledge increase as a result of an educational intervention? Following data analysis, it was demonstrated that this question could not be answered using the questionnaire as written with regard to the construct knowledge. The Depression Attitude Questionnaire did not determine knowledge and did not fit well with a scaled response. Additional data analysis was conducted to assess nurses’ beliefs regarding depression before and after the educational intervention. The Depression Attitude Questionnaire is an attitude/belief questionnaire. The paired t-test was performed to determine whether scores increased as a result of an educational intervention. Based upon the premean and postmean score, it was reasonable to conclude that the educational intervention (which was a Powerpoint presentation) did not make any substantial difference in the nurses’ beliefs related to depression. For Research Question #2: Will nurses’ beliefs related to depression increase their intent to screen patients after an educational intervention? The findings suggest that scores measuring beliefs related to intent to screen (defined as the state of the nurses’ mind that directs him or her toward a special goal {screening for depression in heart failure patients}) were higher after the educational intervention than before the educational intervention, suggesting a greater intent to screen after the educational intervention. A Pearson rcorrelation was performed between the premean and postmean scores to detect any association between beliefs and intent to screen heart failure patients for depression. This did demonstrate a moderately significant correlation. The most interesting finding is the increase in the postmean score after the educational intervention as compared with before, which would suggest that intent to screen increased after the educational intervention.

Conclusion: There has been no published literature specifically linking nurses’ beliefs and knowledge to their intent to screen for depression in heart failure patients. With heart failure readmissions estimated to cost the American public more than $15 billion per year, reducing hospital readmission rates is a national priority. This study provides direct support for the hypothesis that nurses’ beliefs about depression and screening ultimately impact their decisions to use depression screening in heart failure patients. The impact of depression screening on heart failure patient outcomes and on the financial status of health care institutions create a powerful incentive to better educate nurses on the importance of screening in this vulnerable population. Knowledge provides the basis for belief, further supporting the need for education to increase the motivation to routinely screen heart failure patients for depression. Early detection of depression in heart failure patients increases quality of life, which indirectly decreases the readmission rate and corresponding financial burden on healthcare organizations. This study represents a step toward validating a positive correlation between nurses’ beliefs about depression and their intent to screen for depression in heart failure patients.