Post an explanation of the results of your literature review and the connection to your practice problem. Then, explain your synthesis of evidence on which to base a practice change, and the need for a practice change initiative. Be specific and provide examples.

Read a selection of your colleagues’ posts.



Explanation of Literature Review & Connection to Practice Problem 

The PICO framework developed assisted me in developing my critical question (Dang et al., 2021). Many patients within my organization get readmitted with worsening mental and physical health symptoms and often do not follow up with their mental health outpatient appointments.

The World Health Organization [WHO] (2023) cites that mental health concerns that go unaddressed have caused a public health crisis, which has led to morbidities and increased financial burdens for healthcare organizations globally. WHO sites that advanced healthcare practitioners are accountable for educating other healthcare clinicians in their roles for improving all aspects of healthcare with inter-collaboration of care. 

 Article I Research: Presentation to Stakeholders and Connection to Practice Problem  

Does Primary Care Fill the Gap in Access to Specialty Mental Health Care? A Mixed Methods Study –completed by Kaynko, Curry, Keene, Sutherland, Naik, and Busch.  

The practice gap issue within this article identifies a lack of trust between patients and their primary care providers regarding providing mental services while they are referred to a mental health specialty provider. As a Doctor of Nursing Practice student, I would address Kyanko et al. study findings as scientific knowledge that identifies patients’ lived experiences are relevant to their level of engagement in mental health specialty outpatient services.

Kyanko et al. (2022) study identified subjective findings about patients’ ability to access mental health care and identified that addressing mental health screens within the primary care setting is essential while a patient is waiting to receive follow-up for specialty, such as mental health. Kyanko et al. study also identified that PCP providers minimally meet the mental health needs of patients within this setting. In addition, the study participant’s perceptions significantly influence their willingness to receive specialty services related to their mental health diagnosis.  

Article II Research: Presentation to Stakeholders and Connection to Practice Problem  

Stigma, Occupational Injustice, and Individualization of Systemic Issues: Current Issues Faced By Community-Dwelling Adults With Serious Mental Illness–authors are Solaru and Mendonca.  

This article is categorized as level V, considered a lower evidence level. Solaru and Mendonca (2023) research is relevant for integrative clinical practice for identifying mental health stigmas. As a DNP student, I will present Solaru and Mendonca (2023) integrative reviews as a valuable compilation of studies identifying the importance of strengthening the patient and primary care provider relationship bond. I identified clinicians who understand the lived experiences and providing them with educational resources, allows the patient to make informed decisions despite their medical conditions (Solaru & Mendonca, 2023).

Dang et al. (2021) cite that QI projects should consider patients as stakeholders. This integrative review is important for providing knowledge-focused evidence that is patient-centered and aligns with my organization’s mission of providing quality and safe care that adheres to the patient’s right to autonomy during the decision-making process of their care (McEwen & Wills, 2019).  

Article III Research: Presentation to Stakeholders and Connection to Practice Problem  

Inter-professional collaboration reduces the burden of caring for patients with mental illnesses in primary healthcare. A realist evaluation study–authors are De Sutter, M., De Sutter A., Sundahl, Declercg, and Decat. 

I identified with De Sutter et al. (2019) research findings that time management and inter-professional collaboration of care reduce healthcare costs. Patients with an SMI are often readmitted to acute inpatient settings with worsening mental health symptoms and related compromised health issues (De Sutter et al., 2019). Frequent readmissions consume the healthcare costs that organizations and patients have to endure (De Sutter et al., 2019).

Similar findings of high healthcare costs relevant to poor healthcare delivery of SMI patients were mentioned by Kube et al. (2021). De Sutter et al. research findings are supported by WHO (2023) regarding citations of patients with mental health disorders who are more vulnerable and susceptible to poor health outcomes. De Sutter et al. research mirrors WHO reports that social determinants of health and the lack of inter-collaboration enable the clinician to implement and provide effective treatment plans. 

I would present De Sutter et al. (2019) level of evidence to the stakeholders to assist them in identifying that role clarity and time management are necessary to expedite patients to the next level of community care by using inter-collaboration effectively. Intercollaboration of care is necessary for improving communication and minimizing healthcare errors among patients (De Sutter et al., 2019). Primary care settings are the primary source for providing health care to patients (WHO, n.d., as cited in De Sutter et al., 2019). WHO (2023) acknowledges that integrating mental health services within a primary care setting is imperative to the patient’s mental healthcare.

WHO along with De Sutter et al. agrees that patients with SMI should be referred to a specialty mental health provider as evidence shows specialty services are more sensitive and capable of providing the patient’s individualized needs. Stakeholders within my organization would benefit from a guided inter-collaboration approach that will identify post-discharge healthcare resources that provide mental health care within their facility and facilitate community mental health care for the patient’s outpatient needs (De Sutter et al., 2019; WHO, 2023). 

Article IV Research: Presentation to Stakeholders and Connection to Practice Problem  

The Graying of Integrated Health: The Specialized Role of Psychology in Geriatric Primary Care–authors Kube, Harris, and Hicken.  

In multi-disciplinary rounds, there are few discussions regarding targeted groups within the mental health population. Patients with SMI are challenged by social stigmas and medical conditions that impair cognitive functioning (Kube et al., 2021). Although this article does not focus entirely on social stigmas, it is relevant in introducing information to stakeholders regarding an integration model that examines all aspects, inclusive of cognitive awareness challenges that impede patients’ ability to access mental health care (Kube et al., 2021). There are many patients who are challenged with cognitive impairment issues within my facility. 

Also, my hospital organization services many veterans who are shuffled through the system and often get readmitted for the same or worsening mental health conditions. Utilizing an integrative approach with the PACT team will assist VA patients in accessing health care and foster continuity of care while minimizing their symptoms with post-discharge mental health treatments (Kube et al., 2021). I would present to the stakeholders of my organization that improving patients’ ability to access mental health using a collaborative and integrative approach will improve the mental health of patients who have increased barriers to participating in their discharge plans.   

Synthesis of Evidence To Base a Practice Change and Practice Change Initiative 

Synthesizing these four articles has allowed me to identify a gap in practice regarding providers’ understanding of the importance and appropriate interventions in identifying patients who are challenged by social determinants of health and their inability to access mental health services due to these barriers. Specific measures are needed when it comes to integrating social determinants of health screening tools and inter-collaboration of care models (Dang et al., 2021; De Sutter et al., 2019; Kube et al., 2021; Kyanko et al., 2022; Solaru & Mendonca, 2023). Research has revealed that healthcare providers need education on the effectiveness of inter-collaboration practice.

My clinical experience has allowed me to identify missing components in the initial psychosocial admission screen and poor communication amongst inter-disciplinary teams will lead to poor health outcomes (De Sutter et al., 2019; Kube et al., 2021; Kyanko et al., 2022; Solaru & Mendonca, 2023). I understand from experience that clinicians will not collect all the necessary information to complete the screen as this process can be ongoing. However, the concern is that the psychosocial screens are not followed-up by the staff nurses. Poor inter-collaboration of practices has been identified in the DNP project’s three purposed practice settings: an outpatient mental health clinic and a private office providing mental health services. 

The social workers at my hospital are responsible for completing the behavioral health psychosocial screen and rely on the assistance of other healthcare clinicians to add to areas that they did not capture in their assessment. The nurse who provides direct care often does not document other components of social determinants of health information during the patient’s stay. For example, families and significant others have visited over the weekend when the social workers are not present.

This is the time to capture patient-to-family interactions and document the feedback from these encounters. Relevant information regarding the patients’ social needs can go missing with incomplete social determinants of health screens, which can impose barriers to accessing mental health care for the patient post-discharge (De Sutter et al., 2019; Kube et al., 2021; Kyanko et al., 2022; Solaru & Mendonca, 2023). 

I attest that when I come to work on Mondays, I ask the charge nurse about the patient-family visits. The nurses provide a lot of information that is not reflected in the patient’s chart. Social interactions of patients and their families are significant for utilization review purposes, which reflects identifying the patient’s support system before discharge. Studies have shown that patients with poor social interaction and no community support often fail their discharge plan and get readmitted to the inpatient psychiatric facility with worse symptoms (De Sutter et al., 2019; Kube et al., 2021; Kyanko et al., 2022; Solaru & Mendonca, 2023).

I would utilize the relevant research evidence to educate staff or influence stakeholders with policy changes that produce change initiatives for psychosocial screening initiatives relevant to the best healthcare delivery approaches for mental health patients. Integrative practices for inter-collaboration of care are contingent on all disciplines providing as much relevant information as possible regarding the best course of treatment during the patient’s stay and discharge needs. There is a global need to close the practice gaps that enable mental health patients from living optimal and functional lives (WHO, 2023).


Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Walen, M. (Eds.). (2021). Johns Hopkins nursing evidence-based practice: Model and guidelines (4th ed.). Sigma Theta Tau International.    

De Sutter, M., De Sutter, A., Sundahl, N., Declercq, T., and Decat. P., (2019). “Inter-Professional collaboration reduces the burden of caring for patients with mental illnesses in primary Healthcare. A Realist Evaluation Study.” European Journal of General Practice 25 (4): 236–42. doi:10.1080/13814788.2019.1640209.   

Kube, E., Harris, G., & Hicken, B. (2021). The graying of integrated health: the specialized role of psychology in geriatric primary care. Aging & Mental Health, 25(10), 1941–1949. to an external site.   

Kyanko, K. A., A Curry, L., E Keene, D., Sutherland, R., Naik, K., & Busch, S. H. (2022). Does primary care fill the gap in access to specialty mental health care? A mixed methods study. Journal of General Internal Medicine, 37(7), 1641–1647. to an external site.  

McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer.  

Solaru, A. A., & Mendonca, R. J. (2023). Stigma, occupational injustice, and individualization of systemic issues: current issues faced by community dwelling adults with serious mental illnesses. Disability & Society, 38(6), 1076–1083. to an external site.   

World Health Organization. (2023). Mental Health. to an external site.  




Your topic is one that is dear to me as one who runs a nurse staffing agency. As the years go by, I see nurses “Burn Out” in fewer years than ever before. The nursing profession faces substantial challenges with the high annual turnover rate, leading to a concerning shortage of nurses in the healthcare sector. The factors contributing to this problem, such as unfavorable working conditions, inadequate compensation, and limited benefits, are well-documented in the literature (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002).

Additionally, the impending retirement of a significant number of baby boomer nurses further exacerbates the situation and poses a looming threat to the healthcare system’s ability to meet the growing demand for patient care. As nurse leaders, it becomes crucial for us to address these issues proactively through policy advocacy, workforce development initiatives, and innovative retention strategies to ensure a stable and sustainable nursing workforce.

Additionally, optimizing work environments by reducing nurse-to-patient ratios, improving safety measures, and fostering a positive workplace culture can enhance job satisfaction and encourage more nurses to stay in the profession (Kutney-Lee et al., 2019). By combining these strategies, policymakers and healthcare organizations can effectively address the nursing shortage and ensure the provision of high-quality patient care.


Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288(16), 1987-1993. doi:10.1001/jama.288.16.1987

Kutney-Lee, A., Wu, E. S., Sloane, D. M., Kim, Y., & Aiken, L. H. (2019). Changes in Hospital Nurse Work Environments and Nurse Job Outcomes: An Analysis of Panel Data. International Journal of Nursing Studies, 94, 1-8. doi: 10.1016/j.ijnurstu.2019.02.001.

Your well-articulated insights offer an in-depth view of the nursing deficit, giving much thought to ponder. It’s apparent that the crux of the issue lies with less-than-desirable work conditions, confined career growth, and subpar monetary rewards (Smokrović et al., 2022). By examining your synthesis, one can easily identify practice amendments with the potential to curb nursing workforce attrition, paving the way for tackling shortages.

A pivotal factor is bettering workplace atmospheres, which demand duly crediting essential support systems. Employers should prioritize providing nurses with multifaceted sustenance – both physical and emotional (Hawkins & Morse, 2022). Ensuring mentorship programs for novice nurses, harboring camaraderie among coworkers, and introducing adaptable schedules facilitates striking optimum equilibrium between personal and professional lives.

To accentuate nurses’ invaluable endeavors, twofold methods prove advantageous in propelling widespread cognizance regarding their indispensable roles and enhancing their esteem within healthcare circles (Hawkins & Morse, 2022). Encouraging nurse involvement within governing hospital operations promotes job gratification while bolstering patient care determinations (Smokrović et al., 2022).

Securing new prospects in this essential field is imperative for tackling shortages. Education plans for nursing necessitate progression beyond academia to encompass coping strategies to navigate burnout, empathy drain, and stress governance (Smokrović et al., 2022). Preparing prospective nurse generations with practical resilience mechanisms fortifies retention rates and builds a sturdy groundwork for a thriving nursing community (Hawkins & Morse, 2022).

Summarily, your analysis is a testament to the depths of the nursing shortage quandary while shedding light on tangible steps for practice improvements. By pinpointing core causes and rallying principal stakeholders’ involvement in alleviating this predicament, there lies optimism for meaningful advancements in retaining skilled nursing professionals and preserving exceptional patient care standards.


Hawkins, S. F., & Morse, J. M. (2022). Untenable Expectations: Nurses’ Work in the Context of Medication Administration, Error, and the Organization. Global Qualitative Nursing Research9, 233339362211317. to an external site.

Smokrović, E., Kizivat, T., Bajan, A., Šolić, K., Gvozdanović, Z., Farčić, N., & Žvanut, B. (2022). A Conceptual Model of Nurses’ Turnover Intention. International Journal of Environmental Research and Public Health19(13), 8205. to an external site.