Date of Award

Summer 2023

Document Type

Final DNP Paper

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Dr. Kimberly Helms


Background: Postpartum depression (PPD) is a major depressive disorder that can occur after having a baby and anytime during the first year postpartum (Centers for Disease Control and Prevention [CDC], 2021). Symptoms of PPD may include anger, crying more than usual, withdrawing from family, inability to bond with the baby, feelings of anxiousness, or thoughts of the mother harming herself or the baby. PPD can yield many challenges and hinder daily living activities. Recent research by the CDC (2021) estimates that 1 in 8 women experience manifestations of PPD. Findings also suggest that 1 in 5 women were not screened for PPD during a prenatal visit, and roughly 1 in 8 women were not screened during a postpartum visit. The Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN, 2022) reported that perinatal depression affects 1 in 7 pregnant women. Perinatal mood and anxiety disorders are serious health issues in the United States, affecting 600,000 to 900,000 women yearly.

Purpose: The evidence-based Doctor of Nursing Practice (DNP) quality improvement project was to develop a PPD screening protocol to improve the identification of PPD and increase referrals to case management. The project aimed to screen 100 postpartum patients using a PPD screening scale on day one postpartum. A policy and protocol for referral was developed for postpartum patients who screened positive on the Edinburgh Postnatal Depression Scale (EPDS). Written permission was granted for using the EPDS for the DNP project (see Appendix A).

Methods: This quality improvement project used a quantitative design as the outcome measurement for the DNP project and included the total number of patients screened with appropriate referral to case management before discharge (Grech, 2021). Kurt Lewin’s Change Theory was used as the organizing framework for the DNP Project. The Plan-Do-Study-Act (PDSA) cycle was used to guide the project plan, development, implementation, and evaluation of the Quality Improvement (QI) project (Butts & Rich, 2018).

Results: The percentage of patients referred for case management increased from 5% to 18% with the implementation of the survey instrument. The change in the number of patients referred to case management was statistically significant (X2 (1, N = 168) = 7.1182, p = .00763).

Conclusion: The DNP project aimed to implement a PPD screening protocol to assist in the early identification of PPD and increase referrals to case management. The quality improvement project consisted of training and educating nurses in the obstetrical unit to increase awareness of the clinical manifestations of PPD and the PPD screening protocol. The project enabled staff members to educate patients on the clinical manifestations of PPD.


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