The Literature Synthesis

Purpose
The purpose of the discussion this week is to create a plan for the formative evaluation. (Please refer to Fidelity Lesson for this discussion). The intervention must be implemented as planned to achieve outcome success. As the project manager, you will create a process to check if the intervention is being implemented as planned. This process is called the formative evaluation. Intervention fidelity is high when the intervention is implemented almost exactly as planned. Low intervention fidelity indicates there is variance in the intervention implementation.

Instructions
Review this week’s readings and provide your response in 150 words or less:

1. State your practice question in PICOT format.
   PICOT- In adult patients with mild to moderate depression at an outpatient mental health clinic, does implementation of MBSR compared to standard care improve depression symptoms in 8-10 weeks?
2. Describe the formative evaluation plan for your project design, outlining the steps and/or tools you will utilize as the project manager to conduct this week-to-week assessment process.
3. Detail your plan for feedback if the results of the formative evaluation demonstrate low intervention fidelity.
   Use Grammarly and current APA format for the posts.
   Resources
   Intervention Fidelity
   This week’s focus is on the role of the DNP-prepared nurse ensuring intervention fidelity. One very important aspect of implementing an evidence-based intervention is fidelity. Intervention fidelity is the degree to which the intervention is implemented as described in the research, which is essential because the research-based intervention affects the outcomes. If the intervention is implemented as described in the research, the outcomes for the practice change project are more likely to be similar to the outcomes reported in the research. Conversely, if the intervention is not implemented as described in the research, the practice change project outcomes will be different from those in the research. Therefore, standardizing the intervention implementation across team members for the implementation duration is a crucial factor in obtaining the desired outcomes.
   During a practice change project implementation, it is necessary to check the intervention fidelity often to ensure high intervention fidelity. There are many ways to assess the intervention fidelity. One prevalent way to assess intervention fidelity is using a checklist. The checklist contains the main parts of the intervention that must be implemented as described in the research. When the intervention implementation slips and some of the checklist elements are missing, it is necessary to offer feedback to the implementation team to ensure the intervention includes all elements uniformly and in the right order. The frequency for checking intervention fidelity in a practice change project depends on the intervention and the recommendations from the research. Assessing fidelity can be done as often as after every participant receives the intervention to twice weekly. The DNP-prepared nurse leader determines the frequency of the fidelity assessment, and this frequency can change during the implementation as needed.

Attaching the high level steps in my evidence based intervention implementation plan below for you to get an idea.

The evidence based MBSR intervention for mild to moderate depressed patient in outpatient mental health clinics are implemented in three phases that includes participant recruitment, implementation activities, data analyzing and reporting.
• First week week, participants are recruited, obtaining informed consent after explaining project requirements and participant expectations, then performed baseline assessment of depression using the Patient Health Questionnaire-9 (PHQ-9) scale and measure their overall function using Work and Social Adjust scale.
• Second phase will run from week two to nine, where project manager will assist participants in downloading My Possible Self mobile app and help them to do self-directed 45 minutes daily home practice MBSR activities (Hoge et al., 2023). Provide weekly education on mindfulness therapy through Zoom meeting. On the fifth or sixth week conduct a meeting with participants to reinforce the mindfulness practice.
• Last phase includes post-depression assessment performed using PHQ-9 scale and measure overall function using Work and Social Adjust scale. Data will be analyzed for pe and posttest comparison.
Explain the intervention you will implement to address the issue identified based on the needs of the practicum site. Remember, educational only interventions are not allowed. The intervention should be based on the translational science model you have chosen. You must provide an overview of the intervention so the reader(s) will be able to duplicate the intervention on their own.
(Include or attach any relevant documents, if available such as protocols, procedures, guidelines, etc. that you will implement).
Week 1:

• Eligible patients informed about the study project, sign informed consent
• Baseline depression assessment performed using PHQ-9
• Participants instructed on project expectations
  Weeks 2-9:
• Participants allocated to 2-4 groups for weekly in person lessons on mindfulness meditation, and mindful movement based on the Palouse mindfulness based stress reduction program (Hoge et al., 2022). Participants instructed on downloading and using MyPossibleSelf app for daily guidance and logging of MBSR activities. The project leader will collect weekly logs of MBSR activities and schedule VSEE FaceTime or Zoom meetings to review progress and answer questions.
  Week 10:
• Post-test depression assessment performed using the PHQ-9
• Data analyzed for pre-and post-test comparisons.
  Pre and post-test depression assessment will be done using Patient Health Questionnaire-9, a validated tool with high sensitivity, specificity and reliability.

PHQ-9 scores- pre and post PHQ-9 scores to assess depression symptoms
PHQ-9 screening tool does not require permission. It is in the public domain.

Compliance measure- Weekly compliance with log activities