Theory : 1.A Critical Question for Quality... | Nursing

Clinical Requirement:

1.A Critical Question for Quality Improvement Successful Strategies      My original critical (PICO) question was: Can cultural competence training for healthcare workers improve the healthcare workers’ perceptions of and the health outcomes of the LGBTQ+ community? To simplify the search process and improve the focus of my question, I narrowed down the question to exclude the “health outcomes” part because the health outcomes of the LGBTQ+ population would be a secondary outcome resulting from healthcare workers’ perceptions.       My favorite approach to locating current medical articles is using the Walden Library, which searches multiple databases per your chosen filters. If I don’t find enough sources from the Walden Library, I use the free Google Scholar database (although it has fewer filter features). I also frequently use Boolean operators and synonyms for keywords. For example, I searched: -“Cultural competence OR cultural awareness OR cultural competency OR cultural sensitivity OR cultural humility” in one line AND “lgbtq OR sexual minority” in a second line.  -I then filtered the results by “peer-reviewed scholarly journals” and the years “2019-2024.”  -Later, I utilized the third search line to find AND “systematic review OR meta-analysis” to find higher quality articles. -I then searched AND “education OR training OR knowledge OR learning” in the third line to specify the research intervention.       I read through the titles, and some of the abstracts, to ensure that the articles addressed LBGTQ+ cultural competence training and healthcare workers’ perceptions/skills (NOT the patients’ perceptions). Lastly, I began filling in the chart as I identified pertinent articles to verify that the chosen articles contained all the components I needed for the assignment. I was able to locate 10 articles within two days of searching. I then printed and highlighted the chosen articles to concentrate further on the information and better complete the chart.  Issues      The only challenge I encountered during my search process was a limited number of systematic reviews and a lack of randomized controlled trials. However, my understanding of this limitation is that my topic is more of a sociological question that is better investigated and answered via qualitative studies than empirical research. 2.  My literature review aimed to investigate the critical question: Does implementing standardized depression screening and follow-up protocols increase detection and treatment of depression among uninsured primary care patients? I chose this focus because major depression widely afflicts the uninsured primary care population, yet diagnosis and treatment significantly lag behind real-world practice for this group facing substantial health disparities (Rezaeizadeh et al., 2021). Routine screening represents an evidence-based approach to closing this care gap, but inconsistent administration and lack of meaningful follow-up after positive results undermine impact due to system barriers and limited behavioral health resources (Powell et al., 2021). As a result, Hughes and Hughes (2023) note tha major depressive disorder, a highly treatable condition, often persists unaddressed across vulnerable individuals. To find relevant sources on this topic, I utilized the Walden University Library to search databases including CINAHL Plus with Full Text, Health Source, MEDLINE, and PsycINFO. I used keyword search terms like "depression", "screening", "protocol", "uninsured", "primary care", "detection", and "treatment", while limiting results to peer-reviewed research articles published in the last 5 years. This search strategy has yielded numerous applicable studies for my literature review, including both original research and literature syntheses examining depression screening implementation outcomes. While my search has successfully identified analyses of structured depression screening initiatives in primary care, I need more articles focused on uninsured and underserved populations specifically. I would welcome any database suggestions from colleagues for finding sources centered on health disparities and care barriers facing marginalized communities. As I wrap up gathering literature, I want to ensure I capture the full context surrounding my critical question and the equity impacts of standardizing depression detection protocols across fragmented primary care settings. Overall, through this topic I aim to underscore the vital role that nursing leaders and DNPs can play in championing measurement-based care models to systematize evidence-based screening and follow-up. Such clinical system changes have potential to promote mental health equity for society's most vulnerable.