Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Jean Dols


Steven Rodriguez


The purpose of this evidence-based practice project was to increase depression screenings in adults with non-surgical advanced heart failure using reliable and valid tools, 2013 American College of Cardiology Foundation/American Heart Association recommendations, and Healthy People 2020 Target Goals as a method to identify and facilitate appropriate mental health referral, patient education, and follow-up for depressive symptoms. Interventions took place June 5, 2017, through August 10, 2017. This intervention project involving 246 adults with advanced heart failure demonstrated that an evidence-based intervention for depression screenings increased the number of patients screened from 5% to 44%. At project completion, 65% of patients received patient education, 80% were offered a referral for further evaluation, and 81% were scheduled for follow-up. Of the 108 patients screened, 30% had positive Patient Health Questionnaire-2 screenings and 16% had scored on the Patient Health Questionnaire-9 ≥ 10. The analysis of the Patient Health Questionnaire-9 demonstrated that questions 1, 3, 4, and 6 had higher rates of occurrence in a largely Hispanic population of adults with non-surgical advanced heart failure. An analysis of the data demonstrated higher rates of depressive symptoms in patients with a New York Heart Association functional class III (51%) and class C (84%). This project also found that patients with advanced-stage heart failure and depressive symptoms were younger, had higher brain natriuretic peptide levels, and lower left ventricular ejection fractions compared with studies that include all stages of heart failure.