Training nursing staff to recognize depression in home healthcare

Abstract

Objectives: To describe the implementation and acceptability of the TRaining In the Assessment of Depression (TRIAD) intervention, which has been tested in a randomized trial. The primary aim of TRIAD is to improve the ability of homecare nurses to detect depression in medically ill, older adult homecare patients.

Design: Description of the important components of TRIAD, its implementation, and evaluation results from nurse surveys.

Setting: Three certified home healthcare agencies in Westchester County, New York.

Participants: Thirty-six homecare nurses.

Intervention: Participants randomly assigned to TRIAD (n=17) were provided with the opportunity to observe and practice patient interviewing. The approach focused on clinically meaningful identification of the two "gateway" symptoms of depression and is consistent with the newly revised Medicare mandatory Outcome and Assessment Information Set (OASIS-C). Control group participants (n=19) received no training beyond that which agencies may have provided routinely.

Measurements: Baseline and 1-year nurse confidence in depression detection, and postintervention acceptability ratings of the TRIAD intervention.

Results: Participants randomized to the TRIAD intervention reported a statistically significant increase in confidence in assessing for depression mood (P<.001), whereas the usual care group's confidence remained unchanged (P=.34) 1 year later.

Conclusion: An educational program designed to improve depression detection by giving nurses the skills and confidence to integrate depression assessment into the context of routine care can be successfully implemented with homecare agency support. The authors discuss the intervention in terms of OASIS-C and the "real world" realities of intervention implementation.

Figure 1

Outcome and Assessment Information Set (OASIS) item M0590 and training approach to assessment of depression symptoms. Source: 1998, Center for Health Services and Policy Research, UCHSC, Denver CO, OASIS-B1 SOC.