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THE TEN STRATEGIC POINTS 2

The 10 Strategic Points for the Prospectus and Direct Practice Improvement Project

Marian Alli

Grand Canyon University

DNP-815A Scientific Underpinnings

Professor Suzanne Kronsberg

May 29, 2022.

10 Strategic Points Document for a Quality Improvement Project

Ten Strategic Points

The 10 Strategic Points

Title of Project

1) Title of Project

Coping with Mental Health Issues: Suicide Prevention Among Adolescents & Young Adults

Background

Theoretical Foundation

Literature Synthesis

Practice Change Recommendation

2) Background to Chosen Evidence-Based Intervention:

List the primary points for six sections.

i) Background of the practice problem/gap at the project site

The challenge of mental health has become a problem for the adolescents and young people in the society. The issue of mental health is a problem that an individual only understands, and it becomes a problem for the family and parents to notice it early. Suicide among teenagers and young adults is one of society’s most pressing issues right now. Many young people take their own lives because they lack self-confidence, faith in their own abilities, and a foundation of life experiences. Despite this, it is difficult to prevent teen suicides even when the primary causes are understood, because other factors often play a role. Researchers must first examine the causes of suicide ideation and attempts among teenagers in order to determine whether such support can help reduce suicide rates and rates (Patterson, 2016). The young people are finding it difficult in handling mental health issues that affect their productivity. Most of the adolescents and young people are in school that is either high school or college and education is another cause of the mental health issue. Students gets it challenging in balancing their social life and education making them become depressed since their parents have a high expectation from them academically.

ii) Significance of the practice problem/gap at the project site

Several factors contribute to the suicide of adolescents and young adults. However, none of these factors is more important than the stress that young people face today. Furthermore, teenagers are under constant strain and pressure. The speed of modern life is a major stressor for many young people, despite the fact that psychologists say it could be anything. The romanticized portrayal of suicide is a major factor in the suicides of many young people. Many young people don’t seem to care about the fact that suicide is a death sentence. In other words, young people see suicide as a way to express themselves or to make others feel sorry for their mistakes. It’s important to remember that teenagers are prone to rash decisions, and that’s why suicide is often committed in this setting. Teenagers are influenced by suicides that are widely publicized, and as a result, an alarming number of “copy-cat” suicides among children has been documented. Thoughts of ending one’s own life are common in many mental health conditions. Many young people who take their own lives are suffering from severe mental illness. Suicide is frequently accompanied by depression, behavioral issues, and eating disorders. Self-directed violence has also been linked to violence against others by researchers. A teen’s mental health is frequently harmed as a result of a suicide attempt. It is reasonable to assume that a young person who has previously attempted suicide will do so again very soon (Torcasso & Hilt, 2017). On the other hand, a failed suicide attempt may lead to an attitude of gratitude for the life that has been given to you. The negative impact of suicide on one’s peers is also well-documented, as numerous suicides are carried out one right after the other. Suicide warning signs include falling grades, disciplinary issues, and skipping school. These are just a few of the warning signs. The most effective way to prevent this problem is to teach stress management skills to young people. Aside from being aware of suicide warning signs, parents should pay more attention to their children’s emotional health. Parental support is essential for teenagers who are dealing with adolescence’s many challenges (Torcasso & Hilt, 2017). This does not deter teenagers from taking their own lives; they will find ways to do so regardless of the circumstances. Many young people, on the other hand, consider suicide as a last resort but do not intend to take their own life. It is possible to save these children. Statistics show that half of all teenagers who take their own lives do so using firearms that their parents have in the house. As a result, the most important prevention tip is to keep guns out of sight. Suicidal thoughts are brief, lasting only fifteen minutes on average. Learning about mental health issues and suicide prevention among the young people and adolescents is an important move towards addressing the challenge where awareness and educating the youth is undertaken after understanding the challenge in detail.

iii) Theoretical Foundations (choose one nursing theory and one evidence-based change model to be the foundation for the project):

This research will necessitate the acceptance of a number of theories that can aid in the comprehension of the problem being examined. The research will rely heavily on theories relating to stress and suicide. Interpersonal-psychological theory of suicidal behavior by Joiner is an important part of this study. It consists of three main parts (factors that may make an individual to commit suicide). The first component is the burden that an individual perceives to have. A person may feel he or she is under too much pressure from society, family members, or friends as a result of these factors. A person’s well-being may be jeopardized if he or she is under the constant strain of meeting the material needs of the family or the demands of the workplace. Perceived burdens can be real or fictitious according to Patterson (2016). The most important factor is the individual’s perception of the responsibility and expectations that society places on him or her. When a person is overburdened, it is dangerous if they fall into a state of despair. An additional risk factor is a sense of social alienation, which can be characterized by a lack of belonging (Torcasso & Hilt, 2017). The individual believes that society no longer cares about them and that they must come up with their own solutions. When a person loses their fear of suicide, the third component is complete. Suicide may be an option for someone who believes it is the only way to end their suffering (Patterson, 2016). In Klonsky and May’s (2015) research, a person who has all three feelings can easily commit suicide. To them, life has no value, and they believe that the only solution is death.

In healthcare organizations, there are a variety of models for achieving change. The PDSA model’s four steps plan, do, study, and act will be used to effectively implement the DAP project’s activities, which include community/adolescent education, community presentations to increase awareness of depression, and teaching positive coping. The DAP program will be led by a team of school nurses, parents, teachers, and teenagers in the “plan” step. Its responsibilities will include designing the project’s goals, researching the present prevalence of depression and psychiatric treatment among adolescents in the community, and generating educational content and tools. To help guide the process, a study of the teens’ understanding of depression and its symptoms will be done. The following phase, the “Do” stage, is where a program is actually implemented. Public education, encouraging adolescent expression of emotions through painting, and teaching coping strategies will all be part of the DAP program. The evaluation or review of the program falls under the “Study” step. The return on investment, required adjustments, and potential adverse effects are just a few of the aspects that are looked at. “Act” is the final phase in the PDSA process. It comprises a thorough examination of the project’s objectives and outcomes. Preventive efforts, adolescent satisfaction with care and privacy, and an increase in help-seeking behavior in this demographic will all be indicators of this program’s effectiveness.

iv) Create an annotated bibliography using the “Preparing Annotated Bibliographies (APA 7th)” located in the Student Success Center. https://www.gcumedia.com/lms-resources/student-success-center-content/documents/writing-center/preparing-annotated-bibliographies-apa7-mla8-turabian9.pdf utilizing the five (5) original research articles that support the evidence-based intervention. This will be the foundation of the Literature Synthesis you will have to do in DNP-820A.

May, A. M., & Klonsky, E. D. (2016). What distinguishes suicide attempters from suicide ideators? A meta-analysis of potential factors. Clinical Psychology (New York, N.Y.), 23(1), 5-20. https://doi.org/ 10.1111/cpsp.12136

Researchers conducted a comprehensive evaluation of the most recent research to determine whether the suicide rate in the United States has increased or decreased. According to the researchers, there is a lot of study on suicidal risk, but only a handful of these studies have been able to uncover valid risk variables. However, even well-known risk indicators, such as hopelessness, failed to reliably predict the likelihood of suicide thoughts and actions. The conclusions of this study are at odds with established theories and practices of prevention. Additionally, the researchers discovered that most studies compared the risk factors and features of those who had attempted suicide to those who had not attempted suicide. They conclude that in order to completely comprehend the significance of suicide risk and predicting factors, future study should examine those who have tried suicide vs those who have had suicidal ideation.

Barber, C. W., & Miller, M. J. (2014). Reducing a suicidal person’s access to lethal means of suicide: A research agenda. American Journal of Preventive Medicine, 47(3 Suppl 2), S264-S272. https://doi.org/ 10.1016/j.amepre.2014.05.028

Most of the suicide prevention efforts that have been focused on reducing availability to means of suicide have focused on reducing the toxicity of car exhaust (e.g., carbon monoxide) as well as stopping the Romanization of suicide. Death by suicide and lethality of means are linked, according to the findings of researchers. Studies indicated that 30% of those who had contemplated taking their own life experienced a period of intense contemplation lasting around an hour. In addition, they discovered that 90% of those who attempted it did not do it again. To prevent suicide in the United States, the researchers suggest limiting the availability of fatal tools.

Rowhani-Rahbar, A., Simonetti, J. A., & Rivara, F. P. (2016). Effectiveness of interventions to promote safe firearm storage. Epidemiologic Reviews, 38(1), 111-124. https://doi.org/ 10.1093/epirev/mxv006

Researchers conducted a comprehensive meta-analysis of the most recent studies on the effectiveness of limiting access to firearms as an intervention strategy. Nearly every study used some sort of counseling 8, and much research used family practice or pediatric clinic visits to convey the information. Families without firearms in the house received risk information and prevention methods, while families with firearms received the same. Many of these initiatives also provided access to gun locks and safes at a greatly reduced or free rate. Free means-reduction storage devices had the highest success rate, according to the study’s findings. There may be a need for more devices per household if half or more of gun owners have several firearms, the researchers discovered.

Litteken, C., & Sale, E. (2017). Long-term effectiveness of the question, persuade, refer (QPR) suicide prevention gatekeeper training program: Lessons from Missouri. Community Mental Health Journal, 54(3), 282-292. https://doi.org/ 10.1007/s10597-017-0158-z

Pre- and post-tests from Question, Persuade, and Refer (QPR) in Missouri were examined by Litteken and Sale. The researchers wanted to test their theory that QPR is an effective gatekeeper training that has long-term benefits on participants. After taking both post-tests, participants exhibited a better understanding of warning flags. This conclusion, according to the researchers, implies that knowledge of QRP’s efficacy as an intervention hasn’t deteriorated significantly over time. When compared to their prior self-reported data, the researchers also found that the number of adults who reached out to kids increased. Despite these encouraging results, the team was unable to draw any conclusions about the relationship between post-test one and post-test two due to the limited sample size.

Connell, A. M., McKillop, H. N., & Dishion, T. J. (2016). Long-term effects of the family check-up in early adolescence on risk of suicide in early adulthood. Suicide & Life-Threatening Behavior, 46(S1), S15-S22. https://doi.org/ 10.1111/sltb.12254

Research-based program Family Check-Up (FCU) aims to empower parents by identifying their strengths and matching services to existing issues. In a three-session classroom context, motivational interviewing is used. In order to work with school employees, FCU has a tier-based system (IE family resource center staff). According on the results of the assessment, 6th grade students were randomly allocated to one of three treatment groups: a general FCU, a more focused FCU, or a family management treatment group. The students were reassessed at ages 18-19 and 28-30 by the research team. During youth and the early years of adulthood, the researchers found a drop in the suicide risk. Researchers found that broad-based family interventions can reduce risk factors for suicide and other behavioral health difficulties experienced by youth.

v) Summary of the findings written in this section.

The adolescents need to be protected from worsening of mental health as this will impact greatly on their adulthood or end up committing suicide. There is need to do screening of mental health at preliminary stages in order to be able prevent worsening. Prevention and intervention in early stages are main areas that when implemented will reduced the impacts.

Problem Statement

3) Problem Statement:

It is not known if the implementation of suicide prevention awareness and education would impact mental health and suicide cases among the adolescents and young people.

PICOT to Evidence-Based Question

4) PICOT Question Converts to Evidence-Based Question:

In the adolescent population with mental health issues, how does Patient Health Questionnaire-9 (PHQ-9) tool impact in-patient referrals to the mental health department for over 9 weeks?

The PHQ-9 process will be conducted before the intervention from mental health department and after the intervention and this is done for two weeks that is one week before and another week after mental health intervention.

Sample

Setting

Location

Inclusion and Exclusion Criteria

5) Sample, Setting, Location

i. Sample and Sample Size: The sample of the population involved are 10 mental health patients who are adolescents and 5 counselors. The participants are subjected into patient health questionnaire-9 and the process would take two weeks. The first week is filling the questionnaire before intervention and another week questionnaire after the intervention.

i) Setting: A community center setting would be targeted.

ii) Location: Rural locations in Arizona State where they are equally distributed.

iii) Inclusion Criteria

· Who can participate? Adolescents and counselors

iv) Exclusion Criteria

· Who cannot participate: Any other person

Define Variables

6) Define Variables:

i) Independent Variable (Intervention): Therapy/counseling

ii) Dependent Variable (Measurable patient outcome): mental health

Project Design

7) Project Design:

Improvements in patient care are the primary goal of quality improvement initiatives, although research findings need not be immediately implemented into clinical practice. A research is needed to be conducted to ascertain an issue of concern and quality improvement is getting evidence that ensure that the topic of interest is improved.

Purpose Statement

8) Purpose Statement:

The purpose of this quality improvement project is to determine if the implementation of therapy/counseling intervention would impact the mental health well-being among the adolescents. The project was piloted over a nine-week period in a rural setting within Arizona state.

Data Collection Approach

9) Data Collection Approach:

i) You will need data on your participants’ demographic information (example: age, gender, educational background, ethnicity….etc.). What instrument would you use to measure this? (Will you use a pre-made Likert Scale? An Excel Spreadsheet?)

I would use the Excel spreadsheet in collecting the demographic information and measuring them.

ii) You also need data on the measurable patient outcome. What instrument will you use (survey, electronic health records, instrument) to obtain this data and how is it determined to be valid and reliable.

I would use the survey instrument in measuring the patient outcome and the data is determined to be valid or reliable by involving healthcare experts and also using the 15 participants that is enough in getting credible data.

iii) For the instruments used to measure data provide the reliability and validity (psychometric studies) for each.

The survey instrument is reliable in a manner that the data that is collected can be reproduced, and this is done by using structured format. Spreadsheet is known for its effectiveness, reliability and valid in data collection and analysis.

iv) Describe the step -by-step process you will use to collect the data, explain where the data will come from, and how you will protect the data and participants.

I would first conduct the strategic sampling technique where I would target the 10 mental health patients in Arizona State where 5 counselors are selected coming to a total of 15. The mental health patients are then subjected to a questionnaire assessment where each offers the appropriate time for the activity and then fill the questionnaire and the total time allocated for the process is two weeks for all participants and each would take minutes to fill. The information is collected through questionnaire technique where they fill the questionnaire and the detailed information written in spreadsheet for measure. The data is then stored is a well secured computer in an encrypted format and a copy is sent to the cloud.

v) Discuss potential ethical issues pertaining to your project. Ethical Considerations in Human Research Protection (i.e., confidentiality vs anonymity of the data, informed consent, and potential conflict of interest.)

Immediately after the participants accepted to be part of the project, they are required to sign the informed consent form showing that they have agreed to share the data. The informed consent also assure that participants about their confidentiality. It is within the participant ethical right to have the date secured and confidentiality and privacy offered. There should be no potential conflict of interest for the researcher and participant.

vi) Discuss how you will adhere to the principles of the Belmont Report (respect, justice, and beneficence) in the project design, sampling procedures, within the theoretical framework, clinical problem, and clinical questions.

I would analyze the Belmont report and make sure that all the requirements are adhered to in the research study.

Data Analysis Approach

10) Data Analysis Approach:

How will you analyze the participants’ descriptive, demographic information? What statistical analysis will be used to prepare the results?

I would analyze the descriptive data and the demographic information using descriptive statistical approach and demographic analysis.

What type of data analysis will be needed to analyze the measurable patient outcomes? What statistical test will be used? (I.e., chi-square, paired t-test, Wilcoxon…)

I would use the chi-square method.

Will you use Intellectus, Laerd Statistics, or a statistician?

I would use the statistician method since it is appropriate.

Discuss the potential Bias and Mitigation of the data.

The potential bias of the data is that the participants might give misleading information, especially the demographics. The approach to mitigate the challenge is to have a range that a given data is expected to fall for the purpose of having reproducible data.

References

Barber, C. W., & Miller, M. J. (2014). Reducing a suicidal person’s access to lethal means of suicide: A research agenda. American Journal of Preventive Medicine, 47(3 Suppl 2), S264-S272. https://doi.org/ 10.1016/j.amepre.2014.05.028

Connell, A. M., McKillop, H. N., & Dishion, T. J. (2016). Long-term effects of the family check-up in early adolescence on risk of suicide in early adulthood. Suicide & Life-Threatening Behavior, 46(S1), S15-S22. https://doi.org/ 10.1111/sltb.12254

Klonsky, E. D., & May, A. M. (2015). The three-step theory (3ST): A new theory of suicide rooted in the “Ideation-to-action” framework. International Journal of Cognitive Therapy, 8(2), 114-129. https://doi.org/ 10.1521/ijct.2015.8.2.114

Litteken, C., & Sale, E. (2017). Long-term effectiveness of the question, persuade, refer (QPR) suicide prevention gatekeeper training program: Lessons from Missouri. Community Mental Health Journal, 54(3), 282-292. https://doi.org/ 10.1007/s10597-017-0158-z

May, A. M., & Klonsky, E. D. (2016). What distinguishes suicide attempters from suicide ideators? A meta-analysis of potential factors. Clinical Psychology (New York, N.Y.), 23(1), 5-20. https://doi.org/ 10.1111/cpsp.12136

Patterson, S. (2016). Suicide risk screening tools and the youth population. Journal of Child and Adolescent Psychiatric Nursing, 29(3), 118-126. https://doi.org/ 10.1111/jcap.12148

Rowhani-Rahbar, A., Simonetti, J. A., & Rivara, F. P. (2016). Effectiveness of interventions to promote safe firearm storage. Epidemiologic Reviews, 38(1), 111-124. https://doi.org/ 10.1093/epirev/mxv006

Torcasso, G., & Hilt, L. M. (2016). Suicide prevention among high school students: Evaluation of a nonrandomized trial of a multi-stage suicide screening program. Child & Youth Care Forum, 46(1), 35-49. https://doi.org/ 10.1007/s10566-016-9366-x

I, Marian Alli, verify that I have completed and logged 10 clock hours in association with the goals and objectives for this assignment. I also have tracked said practice immersion hours in the Lopes Activity Tracker for verification purposes and will be sure that all approvals are in place from my faculty and practice immersion preceptor/mentor before the end of the course.

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