Registed Nurses' Association of Ontario

Implementation of RNAO’s Best Practice Guideline for Strategies to Support Self-Management in Chronic Conditions. Adult Depression Screening in Cystic Fibrosis

Lisa J Smith
Hotel Dieu Hosptial

The overall goal of this fellowship was to increase my knowledge and skill related to applying a component of the RNAO BPG “Strategies to Support Self-Management in Chronic Conditions” in the Cystic Fibrosis (CF) clinical practice setting. The focus was on the recommendation for depression screening and referral. My goal included learning about effective methods and tools to screen our adult clinic population for depression, and strategies for stakeholder engagement.

Goals were accomplished through the following learning activities:

1. Attended the following Workshops/conferences/webinar/e-learning:

a. RNAO Nursing Best Practice Champions Booster Workshop
b. RNAO Chronic Disease Management Institute
c. Mood & Anxiety Disorders Conference (included workshops & plenaries on evaluation and management of suicidal patients, treatment and management of mood & anxiety disorders in primary care, social anxiety, depression)
d. Canadian Mental Health Association, Kingston Branch

i. Mental Health First Aid (two-day workshop)
ii. Suicide Intervention training
iii. Responding to People in Crisis
iv. Understanding and Facilitating Grief and Loss

e. Choices and Changes workshop: Clinician Influence and Patient Action, Self-Management Program of Southeastern Ontario
f. RNAO Best Practice Champions Network webinar “Integrating Best Practices Using Quality Improvement Methodology”
g. RNAO e-learning module Addictions
h. RNAO e-learning module Screening for Delirium, Dementia, and Depression in the Older Adult

2. Utilized RNAO’s Best Practice Guideline Implementation Toolkit (including “Knowledge to Action Framework” and Toolkitit Worksheets) to guide my Action Plan, Stakeholder and Environmental Readiness Assessment.

3. Conducted a literature review on adult depression and screening tools / methods

4. Reviewed updated survey data regarding the current practice in Canadian CF clinics for mental health screening and care

5. Conducted structured interviews as well as informal discussion with key stakeholders

6. Developed a Mental Health Screening and Referral Algorithm for use in adult CF clinic

7. Reviewed chart audit methodologies, and developed a chart audit tool related to depression screening and referral in CF clinic

By the end of this Fellowship, a formal process was developed for Mental Health screening in the adult CF Program, including a referral algorithm for those who screen positive. This valuable learning opportunity served as a catalyst to improve the quality of patient care through the adoption of evidence-based mental health screening practices and collaboration with Mental Health Services. The knowledge and skills gained in this fellowship also enables me to be a peer resource with expertise in identifying depression co-existing with chronic illness.

I wish to thank my mentors for their support throughout this fellowship. I also want to thank my manager Maureen Pickering, and sponsor organization HDH, for supporting me in this endeavour. A special thanks to RNAO and the Government of Ontario for creating such valuable opportunities for nurses.

Learn more about Advanced Clinical/Practice Fellowships now.